Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-01-08T13:16:47Z No. of bitstreams: 2 license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) endi_lanza_galvao.pdf: 1678820 bytes, checksum: 33907d9247a67c52afa9d562f393c0ac (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-01-11T11:10:26Z (GMT) No. of bitstreams: 2 license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) endi_lanza_galvao.pdf: 1678820 bytes, checksum: 33907d9247a67c52afa9d562f393c0ac (MD5) / Made available in DSpace on 2016-01-11T11:10:27Z (GMT). No. of bitstreams: 2 license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) endi_lanza_galvao.pdf: 1678820 bytes, checksum: 33907d9247a67c52afa9d562f393c0ac (MD5) Previous issue date: 2014 / Desde a cria??o do Sistema ?nico de Sa?de (SUS), o tema regionaliza??o da sa?de tem sido discutido no intuito de implement?-la como estrat?gia de gest?o. Com o objetivo de ampliar a cobertura das a??es e melhorar a qualidade da oferta de servi?os de sa?de, os territ?rios t?m sido organizados regionalmente atrav?s de pactua??es ocorridas nas Comiss?es Intergestores Regional e Comiss?es Intergestores Regional Ampliada. No entanto, contribui??es cient?ficas acerca do planejamento da sa?de no Vale do Jequitinhonha/MG ainda s?o muito escassas na literatura. O presente estudo analisou o processo de planejamento regional desenvolvido por meio dessas comiss?es, durante os anos de 2010 a 2013, no territ?rio da Superintend?ncia Regional de Sa?de de Diamantina/MG. Foi realizado um estudo explorat?rio - descritivo atrav?s de an?lise documental al?m de um estudo epidemiol?gico das interna??es hospitalares por Acidente Vascular Cerebral (AVC), ocorridas em um hospital de refer?ncia da regi?o. Os elementos recolhidos neste estudo mostram que a regionaliza??o do SUS na Regi?o Ampliada de Sa?de Jequitinhonha ? conduzida pelas normatiza??es da Secretaria Estadual de Sa?de e Minist?rio da Sa?de e as Comiss?es Intergestores Regionais parecem configurar uma importante inst?ncia de articula??o entre estado e munic?pios. A rede urbana da regi?o ? formada principalmente por pequenos munic?pios, com destaque para os quatro centros emergentes, Diamantina, Capelinha, Itamarandiba e Ara?ua?, sendo que Diamantina representa o principal eixo articulador de fluxos no setor sa?de. Por?m, os resultados indicam inexist?ncia da pactua??o com a inst?ncia estadual, do fluxo para encaminhamento dos pacientes com AVC. Por?m, verifica-se que a refer?ncia para a cidade de Diamantina j? ocorre sistematicamente, ressaltando a necessidade de concretiza??o desta rede de assist?ncia. / Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Sa?de, Sociedade e Ambiente, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2014. / ABSTRACT Since the creation of the Unique Health System (SUS), the regionalization of health has been discussed with a view to its implementation as a management strategy. In order to extend the coverage of actions and improve the quality of health services on offer, territories have been organized regionally through pacts reached in the Regional Intermanagement Commission and the Extended Regional Intermanagement Commission. However, scientific contributions regarding the planning of health in Jequitinhonha Valley/MG are still very scarce in the literature. The present study analyzed the regional planning process developed by these commissions between 2010 and 2013 in the territory of the Regional Superintendence of Health in Diamantina/MG. A descriptive exploratory study was carried out using documental analysis and an epidemiological study of hospitalizations for stroke in a hospital of reference in the region. The data collected in the present study show that the regionalization of the SUS in the Extended Health Region of Jequitinhonha is coordinated by standardizations of the State Secretary of Health and the Ministry of Health. The Regional Intermanagement Commissions seem to set a significant articulation request between state and city, particularly for smaller cities such as the four emerging centers of Diamantina, Capelinha, Itamarandiba and Ara?ua?. Diamantina represents the main axis of flux in the health sector. However, the results of the present study indicate that there are no pacts with state requests, from the flux to transferring stoke patients. However, it was confirmed that the reference for the city of Diamantina already occurs systematically, emphasizing the need to substantiate this service network.

Made available in DSpace on 2014-12-17T14:46:44Z (GMT). No. of bitstreams: 1 DanieleVD_DISSERT.pdf: 1474768 bytes, checksum: 2c3fc77468bc489daec37da03412db3e (MD5) Previous issue date: 2010-09-03 / Universidade Federal do Rio Grande do Norte / Venous ulcers (VU), recurrent chronic wounds resulting from Chronic Venous Insufficiency (CVI), affect different age groups and would severely affect ambulation of patients. The lesions require treatment lasting and complex and are responsible for significant morbidity and mortality. Thus, this study aims to identify the important aspects covered in the scientific literature protocol for assisting patients with venous ulcers, identifying the issues to be proposed by the judges of the study (nurses, doctors and physiotherapists) to the protocol of care provided to patients venous ulcers and present the structure of protocol proposed by the judges of the study to assist patients with venous ulcers treated at a referral hospital of Rio Grande do Norte. This is a descriptive study using a quantitative approach, carried out at the dressings, located in the outpatient surgical clinic of the Hospital University Onofre Lopes (HUOL), located in East Sanitary District, Natal-RN. The sample consisted of 39 professionals, 30 nurses, seven doctors and two physical therapists, team members HUOL surgical clinic and other public and private institutions of Rio Grande do Norte and Jequi?/Bahia. These professionals were the judges responsible for selecting the guidelines already proposed in the literature on VU protocols. Approved by the Ethics in Research HUOL (Report n.o 081/07), began the first stage of the study which consisted of reviewing the scientific literature about the relevant aspects to be included in a protocol for assisting patients with VU. These aspects were organized into a proposed questionnaire to the judges of the study. Following examination, held on the content validation with application of the Kappa (K), accepting a score higher than 0.80 and the Likert Scale, whereas rates from 4.0 to 5.0. The data collected were organized in Microsoft Excel and exported into Statistical Package for Social Sciences (SPSS) 15.0. The literature review included national and international scientific articles, thesis, dissertation and institutional protocols. Regarding the characterization of professional nurses predominated (76.1%), between 34 and 45 years (41.0%), female (79.5%), married/consensual union (46.2%), with specialization in VU care (61.5%), working in the hospital network (46.1%), with up to 5 years experience in VU (69.2%) and claiming to feel prepared to care for these injuries (92.3 %). With regard to aspects that had very good agreement (K ≥ 0.81), remained the items found in the literature with some modifications. In the analysis of the proposed evaluation items had very important, ranging from 4.1 (drug treatment) to 4.9 (patient assessment and care of the injury and the injured and perilesional skin). The proposition of the protocol is arranged in eleven items: A) Evaluation of patient and lesion, B) Registration and documentation, C) the wound and perilesional skin, D) an indication of coverage, E) Use of antibiotic and pain treatment, F) Surgical treatment of CVI, G) Drug treatment, H) Improving venous return and prevetion of recurrence, I) Referral of patients, J) Training and K) Reference and counter reference / As ?lceras venosas (UV), feridas cr?nicas recidivantes que resultam da Insufici?ncia Venosa Cr?nica (IVC), acometem diferentes faixas et?rias e repercutem de forma severa na deambula??o dos portadores. As les?es requerem tratamento duradouro e complexo e s?o respons?veis por morbi-mortalidade significativas. Diante disso, este estudo tem como objetivos identificar os aspectos relevantes da literatura cient?fica contemplados em protocolo para assist?ncia aos portadores de ?lceras venosas; identificar os aspectos a serem propostos pelos ju?zes do estudo (enfermeiros, m?dicos e fisioterapeutas) para o protocolo de assist?ncia aos portadores de ?lceras venosas e apresentar a estrutura de protocolo proposta pelos ju?zes do estudo para assist?ncia aos portadores de ?lceras venosas atendidos em um hospital de refer?ncia do Rio Grande do Norte. Trata-se de um estudo descritivo, com abordagem quantitativa, realizado no setor de curativos, situado no ambulat?rio de cl?nica cir?rgica do Hospital Universit?rio Onofre Lopes (HUOL), localizado no Distrito Sanit?rio Leste, em Natal-RN. A amostra foi composta por 39 profissionais, sendo 30 enfermeiros, 7 m?dicos e 2 fisioterapeutas, integrantes da equipe de cl?nica cir?rgica do HUOL e de outras institui??es p?blicas e privadas do Rio Grande do Norte e de Jequi?/Bahia. Esses profissionais foram os ju?zes respons?veis por selecionar as diretrizes j? propostas na literatura sobre protocolos de UV. Aprovado pelo Comit? de ?tica em Pesquisa do HUOL (Parecer n.o 081/07), iniciou-se a primeira etapa do estudo que consistiu na realiza??o de revis?o de literatura cient?fica acerca dos aspectos relevantes a serem contemplados em um protocolo para assist?ncia aos portadores de UV. Esses aspectos foram organizados em um question?rio proposto aos ju?zes do estudo. Ap?s aprecia??o, realizou-se a valida??o de conte?do com aplica??o do ?ndice Kappa (K), aceitando-se escore superior a 0,80 e da Escala de Likert, considerando ?ndices de 4,0 a 5,0. Os dados coletados foram organizados no Microsoft Excel e exportados para Statistical Package for Social Science (SPSS) 15.0. O levantamento da literatura contemplou artigos cient?ficos nacionais e internacionais, tese, disserta??es e protocolos institucionais. Quanto a caracteriza??o dos profissionais predominaram enfermeiros (76,1%), entre 34 e 45 anos (41,0%), sexo feminino (79,5%), casados/uni?o consensual (46,2%), com especializa??o na ?rea de cuidado a UV (61,5%), atuando na rede hospitalar (46,1%), com at? 5 anos de experi?ncia em UV (69,2%) e alegando sentir-se preparado para cuidar dessas les?es (92,3%). No que diz respeito aos aspectos que obtiveram concord?ncia ?tima (K ≥ 0,81), permaneceram os itens encontrados na literatura com algumas modifica??es. Na an?lise dos aspectos propostos, os itens obtiveram avalia??o muito importante, variando de 4,1 (tratamento medicamentoso) a 4,9 (avalia??o do paciente e da les?o e cuidado com a ferida e a pele perilesional). A proposi??o do protocolo est? disposta em onze itens: A) Avalia??o do paciente e da les?o, B) Registro e documenta??o, C) Cuidado com a ferida e a pele perilesional, D) Indica??o de cobertura, E) Uso de antibi?tico e tratamento da dor, F) Tratamento cir?rgico da IVC, G) Tratamento medicamentoso, H) Melhoria do retorno venoso e preven??o de recidiva, I) Encaminhamento dos pacientes, J) Capacita??o profissional e K) Refer?ncia e contra-refer?ncia

Made available in DSpace on 2014-12-17T15:30:49Z (GMT). No. of bitstreams: 1 EzildaM.pdf: 2533309 bytes, checksum: b6169b9416c9ed1e27f6fcddf5e4e2e8 (MD5) Previous issue date: 2007-08-27 / The public dental services in Brazil were limited, practically, to the basic care, so that the specialized services acted, up to 2002, no more than 3,5% of the total of clinical procedures. That lower offer reveals the difficulty of continuity of the attention, that is, the comprehensiveness in the assistance, particulary, the reference and counter-reference system. Brasil Sorridente search to supply those needs when proposing Speciality Dental's Centers(CEOs Centros de Especialidades Odontol?gicas, Brazil) to compose the services of average complexity. In 2005, Ministry of Health enabled the three CEOs of Natal, located in the North II, East and West Sanitary Districts. This investigation evaluated the implantation of these CEOs, as support of the family health care teams, in the perspective of organization of the services in assistencial nets in Natal/RN. It was a study of evaluation, with qualitative approach and some quantitative data as contribution. Dentists, users and managers were interviewed to identify and to understand their perceptions, relationships and experiences in the daily of the services. The conceptual base that orientated the investigation was the principle of comprehensiveness, in its operational sense of the hierarchization in health attention levels. The collection of data was done with documental research, direct observation and semi-structured interview. The analysis was accomplished by triangulation of the extracted content from the used techniques and sources of interviewed groups depositions, looking for theoretical-conceptual support in specific bibliography. The results pointed aspects that go away from the comprehensiveness like: low resolution of problems in the basic net; little valorization of the space in the health units; traditional models of access to health services, insufficient offer for some specialties, compromising the reference and counter-reference system; practices centered in procedures in the CEO; bureaucratic directions from basic care to the specialized service; disintegrated and disjointed system among levels of attention; disrespect to the municipal protocol. On the other hand, there is an approach of compreensiveness in situations like: increase of the access and covering in the Family Health Strategy (ESF Estrat?gia Sa?de da Fam?lia, Brazil); larger approach between professional and user; tendency to the quantitative and qualitative growth of specialized actions; punctual initiatives of relationships among levels; existence of protocol to guide professionals / A presta??o de servi?os odontol?gicos p?blicos no Brasil restringiu-se, praticamente, ? aten??o b?sica, de modo que os servi?os especializados representaram, at? 2002, n?o mais que 3,5% do total de procedimentos cl?nicos. Essa baixa oferta revela o comprometimento da continuidade da aten??o, isto ?, a integralidade no ?mbito assistencial, e do pr?prio sistema de refer?ncia e contra-refer?ncia. O Brasil Sorridente busca suprir essas necessidades ao propor os Centros de Especialidades Odontol?gicas (CEOs) para compor os servi?os de m?dia complexidade. Em 2005, o Minist?rio da Sa?de habilitou os tr?s CEOs de Natal, localizados nos Distritos Sanit?rios Norte II, Leste e Oeste. Esta investiga??o avaliou a implanta??o destes CEOs, como suporte das equipes de sa?de da fam?lia, na perspectiva de organiza??o dos servi?os em redes assistenciais no munic?pio de Natal/RN. Tratou-se de um estudo de avalia??o, com abordagem qualitativa, tendo alguns dados quantitativos como aporte. Foram entrevistados dentistas, usu?rios e gestores para identificar e compreender suas percep??es, suas rela??es e suas experi?ncias no cotidiano dos servi?os. A base conceitual que norteou a investiga??o foi o princ?pio da integralidade, no seu sentido operacional da hierarquiza??o dos n?veis de aten??o ? sa?de. A coleta de dados se deu por meio de pesquisa documental, observa??o direta e entrevista semi-estruturada. A an?lise foi realizada por triangula??o do conte?do extra?do das t?cnicas utilizadas e de fontes de depoimentos dos grupos entrevistados, buscando apoio te?rico-conceitual em bibliografia espec?fica. Os resultados apontaram aspectos que se distanciam da integralidade como: baixa resolu??o de problemas na rede b?sica; pouca valoriza??o do espa?o nas Unidades de Sa?de; modelos tradicionais de acesso aos servi?os; oferta insuficiente para algumas especialidades, comprometendo o sistema de refer?ncia e contra-refer?ncia; pr?ticas centradas em procedimentos no CEO; encaminhamentos burocr?ticos da aten??o b?sica ? especializada; sistema desintegrado e desarticulado entre n?veis de aten??o; desrespeito ao protocolo municipal. Por outro lado, h? uma aproxima??o da integralidade em situa??es como: aumento do acesso e cobertura na Estrat?gia Sa?de da Fam?lia (ESF); maior aproxima??o entre profissional e usu?rio; tend?ncia ao crescimento quantitativo e qualitativo de a??es especializadas; iniciativas pontuais de rela??es entre n?veis; exist?ncia de protocolo para orientar profissionais

Made available in DSpace on 2014-12-17T14:46:56Z (GMT). No. of bitstreams: 1 DanieleVD_TESE.pdf: 4938953 bytes, checksum: ba81cf3eb020178b1818aa9393647bed (MD5) Previous issue date: 2014-06-06 / Universidade Federal do Rio Grande do Norte / Venous ulcers are lesions resulting from chronic venous insufficiency, venous valvular abnormalities and venous thrombosis. Its occurrence has been growing with the increase in life expectancy of the world population. Considered as fundamental aspects in the approach to the person with venous ulcer care with the interdisciplinary approach, adoption of protocol-specific knowledge, technical skill, coordination between levels of care complexity of the Health System and active participation of patients and their families, a holistic perspective. The construction of a clinical protocol for people with venous ulcers can help professionals of high complexity services in patient assessment and the establishment of quality care in a systematic way and focused on the factors that interfere with wound healing. Thus, this study aimed to analyze the evidence of validation of a clinical protocol for people with venous ulcers treated at high-complexity services. This is a methodological study with a quantitative approach, developed in three stages: literature review, evidence of content validity and evidence of validation in the clinical context. Approved by the Federal University of Rio Grande do Norte Research Ethics Committee (Opinion: 147.452 and CAAE: 07556312.0.0000.5537). The literature review was conducted in August and September 2012, becoming the basis for the construction of the protocol. Then the evidence of content validity, which included 53 judges (experts) selected by the Lattes platform to evaluate the protocol items was performed. The judges were contacted by e-mail and rated the protocol via Google Docs <docs.google.com>. After analyzing the ratios obtained in this step, which reported kappa between 0.75 and 0.96 and between 0.80 and 0.98 IVC, and the suggestions of the judges, the protocol was adjusted and subjected to empirical evidence to validate the clinical setting at the University Hospital Onofre Lopes in Natal / RN. Evidence of validation in the clinical setting involved 4 judges who acted in pairs (paired) evaluated 32 patients with venous ulcers in the clinical context of high complexity. In both stages, we used the Kappa Index and Content Validity Index to analyze the responses of the judges. The parameters set as acceptable for these indices were: Kappa &#8805; 0.61 and Content Validity Index > 0.80. Any evidence of content validity, as evidence of validation in the clinical context, the protocol items that have not reached Kappa and Content Validity Index established indices were excluded and some items were modified or added after suggestions. The process of content validation evidence and evidence of validation in the clinical setting allowed the improvement of the protocol for the care of people with venous ulcers initially proposed. The initial version of the protocol, built from the literature, contained 15 categories and 108 items; after evidence of content validity, remained the reduction to 15 categories with 91 items; the final version, clinically validated, is composed of the same 15 categories, 76 items. The protocol was validated in its content and in the clinical aspect, so we accepted the alternative hypothesis in the study. This protocol may contribute to the care system, allowing tailor behaviors and promote greater resolution in the treatment of people with venous ulcers in health services of high complexity / As ?lceras venosas s?o les?es resultantes da insufici?ncia venosa cr?nica, anomalias valvulares venosas e trombose venosa. Sua ocorr?ncia vem crescendo com o aumento da expectativa de vida da popula??o mundial. Consideram-se aspectos fundamentais na abordagem ? pessoa com ?lcera venosa a assist?ncia com atua??o interdisciplinar, ado??o de protocolo, conhecimento espec?fico, habilidade t?cnica, articula??o entre os n?veis de complexidade assistencial do Sistema ?nico de Sa?de e participa??o ativa dos pacientes e seus familiares, em uma perspectiva hol?stica. A constru??o de um protocolo assistencial para pessoas com ?lcera venosa pode auxiliar os profissionais dos servi?os de alta complexidade na avalia??o do paciente e no estabelecimento de uma assist?ncia de qualidade, de forma sistematizada e focada nos fatores que interferem na cicatriza??o da les?o. Assim, este estudo objetivou analisar as evid?ncias de valida??o de um protocolo assistencial para pessoas com ?lceras venosas atendidas em servi?os de alta complexidade. Trata-se de um estudo metodol?gico, com abordagem quantitativa, desenvolvido em tr?s etapas: revis?o da literatura, evid?ncia de valida??o de conte?do e evid?ncia de valida??o no contexto cl?nico. Aprovado pelo Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte (Parecer: 147.452 e CAAE: 07556312.0.0000.5537). A revis?o da literatura foi realizada em agosto e setembro de 2012, tornando-se a base para a constru??o do protocolo. Em seguida, foi realizada a evid?ncia de valida??o de conte?do, que incluiu 53 ju?zes (especialistas) selecionados por meio da plataforma Lattes, para avaliar os itens do protocolo. Os ju?zes foram contatados por e-mail e avaliaram o protocolo via Google Docs <docs.google.com>. Ap?s a an?lise dos ?ndices obtidos nesta etapa, que apresentaram Kappa entre 0,75 e 0,96 e IVC entre 0,80 e 0,98, e as sugest?es dos ju?zes, o protocolo foi ajustado e submetido ? evid?ncia de valida??o no contexto cl?nico, no Hospital Universit?rio Onofre Lopes em Natal/RN. A evid?ncia de valida??o no contexto cl?nico envolveu quatro ju?zes, que atuaram em duplas (pareados), avaliando 32 pacientes com ?lceras venosas no contexto cl?nico de alta complexidade. Nas duas etapas, utilizaram-se o ?ndice Kappa e ?ndice de Validade de Conte?do para analisar as respostas dos ju?zes. Os par?metros estabelecidos como aceit?veis para esses ?ndices foram: Kappa &#8805; 0,61 e ?ndice de Validade de Conte?do > 0,80.Tanto na evid?ncia de valida??o de conte?do, como na evid?ncia de valida??o no contexto cl?nico, os itens do protocolo que n?o atingiram os ?ndices Kappa e ?ndice de Validade de Conte?do estabelecidos foram exclu?dos e alguns itens foram modificados ou inclu?dos ap?s sugest?es. Os processos de evid?ncia de valida??o de conte?do e evid?ncia de valida??o no contexto cl?nico permitiram o aprimoramento do protocolo para o cuidado ? pessoa com ?lcera venosa, proposto inicialmente. A vers?o inicial do protocolo, constru?do a partir da literatura, continha 15 categorias e 108 itens; ap?s a evid?ncia de valida??o de conte?do, mantiveram-se as 15 categorias com redu??o para 91 itens; a vers?o final, validada clinicamente, ? composta das mesmas 15 categorias, sendo 76 itens. O protocolo foi validado em seu conte?do e no aspecto cl?nico, sendo assim, aceitou-se a hip?tese alternativa no estudo. Esse protocolo poder? contribuir para a sistematiza??o da assist?ncia, permitindo adequar condutas e promover maior resolutividade no tratamento da pessoa com ?lcera venosa em servi?os de sa?de de alta complexidade