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The syndrome commonly referred to as whiplash injury" resulting from motor vehicle accidents is complex and remains a challenge to clinicians, as is evidenced by the recent report of the Quebec task force on the "whiplash syndrome". The main objective of this prospective randomised study was to evaluate two conservative treatment regimens (early immobilisation-experimental group-1, early active mobilisation experimental group-2) which are based on accepted physiological rationale and then to compare their effectiveness with existing treatment regimens that are commonly practiced (control group) in the management of "whiplash" type of injuries. To this stage, the current study is the only prospective randomised clinical trial of its type conducted with a sufficiently large sample size and over a long study period. The results of the current study clearly demonstrated that the subjects in the immobilised group recovered from their pain-related symptoms and returned to their normal duties sooner than those in the other two treatment groups. In addition to this, those subjects who received the immobilisation regimen did not show adverse effects on either the range of motion or the strength of the neck muscles. Thus, the immobilisation regimen was clearly shown to be the preferred option when compared to the other two treatment methodologies investigated in the current study.Although the primary interest of the current study was to compare the efficacy of three different treatment regimens, a series of statistical analyses were performed to establish the prognostic significance of several factors associated with "whiplash" injury. This showed that factors such as gender, age, speed of the vehicles involved, paraesthesia, intensity of pain at the time of the initial examination, interscapular pain, blurred vision and difficulty in focusing, all had prognostic value. ++ / Similarly, the type of collision, seating position, presence of headache within 24 hours post injury, pre-existing degenerative changes in the cervical spine, loss of lordosis and litigation factors had no prognostic significance. Another major emphasis of the current study has been to concentrate on the pain related symptoms of the neck which are of major concern to "whiplash" subjects and to those clinicians treating them. A paucity of such information is considered to be one of the most notable causes of difficulties encountered in the management of "whiplash" injuries.As an adjunct to the main study, the morphology of the deep pre- and post vertebral muscles of the neck region using embalmed cadavers and fresh post-mortem specimens was investigated, as the literature is deficient in--this regard. Similarly, a longitudinal study of 45 subjects was also performed using Magnetic Resonance Imaging (MRI) technology. The longitudinal nature of the M.R.I. study provided for the first time an account of the details associated with the progressive pathological changes that occurred in some disc lesions, at defined points in time following a MVA. The observations made from the adjunct studies help develop a better understanding of the pathoanatomy associated with the deep muscles of the neck region and the pathological changes that occur following a traumatic disc lesion as evidenced within 2 weeks, after 3 months and 12 months post- injury. On the basis of the observations made in the current study, a classification of the "whiplash" injury has been proposed for the consideration of clinicians. Similarly, the questionnaire used for data collection in the current study, can be readily modified and utilised in a clinical situation for establishing documentation, planning treatment strategies and for evaluation of the treatment outcomes of "whiplash" type of injuries.

Magister Public Health - MPH / In Zambia, there had been a large scaling up of new interventions to control malaria since 2003, which included the distribution of rapid diagnostic tests (RDTs), used to immediately determine if someone with symptoms suggestive of malaria actually has malaria; training of health workers in the use of the RDTs; and the prescription of artemisinin-based combination therapy (ACT) to which the malaria parasite is sensitive, rather than the old treatment regime of chloroquine to which the malaria parasite had become resistant. The use of RDTs to confirm the presence of malaria before treating for it with ACT became known as the „test and treat‟ policy. Previously, since the 1960s, in malaria endemic areas such as Zambia, children presenting with fever (the commonest symptom of malaria) without any obvious other cause for the fever, were assumed to have malaria and were hence treated for it with chloroquine. This was known as "presumptive treatment" of malaria. The combination of "presumptive treatment" and the use of a single medication led to the development of high levels of resistance to chloroquine, to the extent that it is now no longer an effective treatment for malaria. Years after the introduction of the "test and treat" policy, it was still unclear to what extent it was being implemented, as there was initial reluctance by health workers to test all children presenting with fever for malaria and if they did test they may not have followed the management guidelines of treating those who test positive with ACT and further investigating those who test negative for the cause of the fever. It seemed that staff had gotten used to the "presumptive treatment" approach to malaria over almost 4 decades and hence were quite reluctant to abandon it. The conflicting guidelines for malaria treatment in children between IMCI and "test and treat‟ has promoted a paradox between presumptive treatment for malaria and "test and treat" approach as IMCI teaches health workers to treat febrile children presumptively for malaria whereas the "test and treat" approach requires them to first make a definitive diagnosis before treating. Hence although the "test and treat" approach was instituted to overcome the problems with presumptive treatment approach it now had to contend with the competing and contradictory influence of the IMCI approach. This study therefore aimed to assess what proportion of children aged five years and younger who presented with fever were managed via the "test and treat" guidelines and which factors were associated with this, in Lusaka District, Zambia. Methodology: A cross sectional analytical study design was used based on a review of medical records. A sample size of 800 medical records of children presenting with fever was selected from 10 out of the 23 health care facilities in Lusaka, using a multistage stratified random sampling technique. Four hundred records were sampled from 2008 records (five years after commencement of the "test and treat" policy) and 400 from 2011 records (eight years after commencement of the "test and treat" policy). Trained data collectors used a data extraction tool to transcribe demographic and clinical data from the medical records in a standardized manner. Data Analysis: Univariate descriptive statistics analysis was performed using measures of central tendency and measures of dispersion to analyze numerical (continuous) variables such as age, weight and body temperature; and using frequencies for categorical variables such as gender, area of residence, RDTs/microscopy malaria tests conducted, received ACT if RDT positive, presence of an ACT treatment chart on the health centre wall and availability of a weighing scale. To determine the relationship between variables, bivariate analysis via the prevalence ratio was conducted. Results: Just over half (55%) of all children with fever were tested for malaria in 2008 and this gratifyingly increased to (73%) in 2011. Overall, the proportion of children correctly and appropriately treated with ACT, which means that those who tested positive for malaria were given ACT, was 85% in 2008 but regrettably dropped to 72% in 2011. Although "presumptive treatment" decreased from 24% in 2008 to 11% in 2011, the proportion of children with fever not tested for malaria, and although not treated for malaria, but left without a definitive diagnosis of their fever being made, remained high but dropping (22% in 2008 and 16% in 2011). Similarly the proportion of children who tested negative for malaria but then did not undergo any further investigation also unfortunately remained very high and rising (57% in 2008 and 89% in 2011). A combination of the above poor clinical management practises resulted in only 38% of children with fever in 2008 and unfortunately dropping to only 33% in 2011 being correctly managed (tested for malaria via RDT or microscopy and treated with ACT if positive, while further investigated for the cause of fever if negative). On preparedness of the health facility to implement the "test and treat" policy, it was noted that only 4 out of 10 health facilities were at least minimally prepared to do so, but paradoxically on bivariate analysis those minimally prepared were less likely (PR 0.62; 95% CI 0.41-0.94) to correctly manage the patients in 2011 than those who were unprepared. A similar paradox occurred for those correctly treated with ACT after testing positive, with facilities which were minimally prepared being less likely to do so (PR 0.28; 95% CI 0.14-0.58) in 2011 than those facilities which were unprepared to implement the "test and treat" policy. However these associations were inconsistent over time, as the associations were not present in 2008. Similarly all other factors such as staff category (doctor, nurse, clinical officer) and type of presenting symptoms besides fever (anorexia, lethargy, pallor) assessed, were not consistently associated with testing for malaria in both 2008 and 2011. The same applied for the other two main outcome variables of 'treated with ACT after test positive for malaria' and 'correctly managed child with fever', in that there were no factors that showed a consistent association with them in both 2008 and 2011. Conclusion: Testing of children with fever for malaria is at a low level but rose between 2008 and 2011. Paradoxically the proportion of those diagnosed with malaria who were correctly treated with ACT dropped between 2008 and 2011, as did the proportion of children with fever who were correctly managed. No factors assessed in this study were found to be consistently associated in both 2008 and 2011 with either testing for malaria, or treating confirmed malaria cases with ACT, or managing patients with fever correctly. Recommendations: In order for health workers to correctly implement the "test and treat" policy, which involves a series of complex steps, they ought to be formally trained to do so, mentored and constructively supervised. Additionally health facilities should be adequately equipped to enable health workers to fully implement the policy. Further studies to assess factors associated with the correct management of malaria via the "test and treat" policy are warranted.

South African incidence of rape ranks amongst the highest worldwide. No direct policy exists for the emergency care provider management of rape victims in the pre-hospital setting. The pre-hospital exposure to rape cases is unknown as its health information system is not gender-based violence sensitive. In the absence of a clearly defined protocol, indiscretion in the emergency care treatment of rape victims remains undocumented. As a particularly vulnerable group globally, victims of rape are deserving of focused intervention. A qualitative, descriptive approach guided the research in which nine semi-structured voluntary interviews were held with emergency care providers, forensic medical practitioners and emergency consultants. Through a critical theory lens thematic content analysis was employed. University of Cape Town ethics approval was attained. The study found that pre-hospital providers lack knowledge and skills of rape victim identification and management but are desirous of evidence-informed guidelines for treatment and referral in a multidisciplinary approach. Educational and policy deficiencies are documented. The recommendations support a community of practice that is mutually inclusive of specialist rape-care centres, emergency department and pre-hospital providers in the interest of forensic emergency medicine. Due regard must be had for needs of practitioners at risk of vicarious traumatization from sexual assault management. Transformative curricula and responsive clinical guidelines are likely to redress any complicity of the health sector non-response to rape/sexual assault. This study is likely to benefit emergency care regulators, educators and researchers whose professional interest is to promote responsivity of the health system to rape.

Submitted by Maicon Juliano Schmidt (maicons) on 2015-07-15T17:01:05Z No. of bitstreams: 1 Viviane Schreiber de Souza.pdf: 582806 bytes, checksum: 002ea2ec3066a664cb5c38beb41c4702 (MD5) / Made available in DSpace on 2015-07-15T17:01:05Z (GMT). No. of bitstreams: 1 Viviane Schreiber de Souza.pdf: 582806 bytes, checksum: 002ea2ec3066a664cb5c38beb41c4702 (MD5) Previous issue date: 2014-01-31 / Nenhuma / Os idosos compõem um segmento da população mundial em crescimento constante. A mudança demográfica da população brasileira nos leva a pensar sobre os serviços existentes que não são suficientes para dar suporte para esta nova demanda. O ramo de hotelaria voltado ao cuidado de idosos, denominado de residenciais geriátricos, vem se mostrando promissor e crescente. Entre os fatores elenca-se: o número crescente de idosos, a redução do tamanho das famílias e a alteração no modo de vida do brasileiro. Essa constatação nos remete a pensar no aumento significativo da demanda por esse perfil de serviços nos próximos anos. Dessa maneira, este estudo visa a implantar a gestão administrativa e de enfermagem em um residencial geriátrico da grande Porto Alegre através de um estudo de intervenção. As atividades de intervenção realizadas resultaram na construção e na definição da missão e da visão do negócio e na identificação do perfil do cliente a ser atendido pelo residencial. O diagnóstico situacional baseado no modelo IDEALS de Facione possibilitou o mapeamento de todos os recursos físicos e humanos do residencial; este estudo possibilitou a construção do instrumento de avaliação geriátrica, buscando as melhores práticas de avaliação clínica. A elaboração dos Procedimentos Operacionais Padrão administrativos e de enfermagem conforme Colenghi foram criados de acordo com as necessidades mapeadas inicialmente no residencial geriátrico. A realização do mapeamento de todos os recursos físicos e humanos, através do diagnóstico situacional, possibilitou o conhecimento da realidade institucional e foi de extrema importância para a implantação de estratégias e programas capazes de auxiliar na organização e elaboração de propostas de melhorias nas condições de trabalho e na construção e consolidação de um instrumento de gestão. Com o intuito de propor soluções e melhorias para os problemas elencados, o presente trabalho possibilitou um direcionamento gerencial não apenas administrativo, mas de enfermagem para o residencial geriátrico, tornando-o diferenciado e competitivo enquanto empresa prestadora de serviços. / The elderly make up a segment of the world's growing population. The demographic shift of the population leads us to think about the existing services are not sufficient to provide support for this new demand. The hotel industry returned to the care of the elderly, called residential geriatric, has proved promising and growing. The associated factors: the growing number of elderly, reducing the size of families and the change in the lifestyle of the Brazilian. This observation leads us to think of the significant increase in demand for this listing services in the coming years. Thus, this study aims to deploy the administrative and nursing management in a geriatric residential Greater Porto Alegre through an intervention study. Intervention activities conducted resulted in the construction and definition of the mission and vision of the business and the identification of the client profile to be serviced by residential. The situation analysis based on the IDEALS of Facione model enabled the mapping of all physical and human resources of residential, this study allowed for the construction of the instrument of geriatric assessment seeking best practices for clinical assessment. The development of standard operating procedures and administrative nursing as Colenghi were created as needed initially mapped in geriatric residential. The completion of the mapping of all physical and human resources through situation analysis, made possible knowledge of the institutional and it was extremely important for the implementation of strategies and programs that assist in the organization and preparation of proposals for improvements in working conditions and the construction and consolidation of a management tool. In order to propose solutions and improvements for the problems listed, the present study allowed a managerial direction not only administrative, but for geriatric nursing home making it as competitive and differentiated services company.

Book Summary: Tinnitus: A Multidisciplinary Approach provides a broad account of tinnitus and hyperacusis, detailing the latest research and developments in clinical management, incorporating insights from audiology, otology, psychology, psychiatry and auditory neuroscience. It promotes a collaborative approach to treatment that will benefit patients and clinicians alike. The 2nd edition has been thoroughly updated and revised in line with the very latest developments in the field. The book contains 40% new material including two brand new chapters on neurophysiological models of tinnitus and emerging treatments; and the addition of a glossary as well as appendices detailing treatment protocols for use in an audiology and psychology context respectively.

Das Ovarialkarzinom ist das 4. häufigste Malignom der europäischen Frau, nimmt aber mit seiner schlechten Prognose den 1. Platz in der Mortalitätsstatistik der gynäkologischen Malignome ein. Die vorliegende Habilitation diskutiert auf Basis eigener Studien den Polymorphismus des Il-1 Rezeptorantagonist-Gen (Il-1RA) als pärdisponierenden Faktor, den prognostischen Stellenwert des Nachweises epithelilaler Tumorzellen im peripheren Blut und die Wertigkeit verschiedener diagnostischer Methoden, wie der Nachweis des Cancer Associated Serum Antigens (CASA) und der Magnetresonanztomographie (MRT). Ferner wird das therapeutische Management des fortgeschrittenen Ovarialkarzinoms präsentiert und kritisch thematisiert. Hierzu zählt das operative, häufig multiviszerale Vorgehen bei der Erstdiagnose als auch die adjuvante systemische Chemotherapie. Die zytostatische Rezidivtherapie findet in dieser Arbeit zusätzlich besondere Berücksichtigung. Klinische Studien stellen unbestritten die Grundlage weiterer Therapieoptimierungen dar. Ausserdem konnten retrospektive Untersuchungen zeigen, dass Patientinnen, die ihre Krebsbehandlung im Rahmen einer Studie erhalten, deutlich bessere Therapieergebnisse aufzeigen als Patientinnen, die ausserhalb von kontrollierten Protokollen behandelt wurden. Daher ist es wichtig, die Gründe für eine Nichtbeteiligung an klinischen Studien zu identifizieren. Die verschiedenen Ursachen für eine Nicht-Teilnahme aus Sicht der Patienten sind mehrfach beschrieben worden. Daher wurden an alle gynäkologischen Abteilungen in Deutschland (mind. 45 Betten), die sich nicht an beteiligten, ein Fragebogen zur Erfassung der Gründe für die Nicht-Teilnahme versendet. Infrastrukturelle Probleme scheinen hiernach für Kliniken in Deutschland die wichtigste Barriere für eine Teilnahme an klinischen Studien zu sein. Diese Ergebnisse sollten in der Diskussion der wissenschaftlichen Fachgesellschaften mit den Leistungsträgern und Vertretern der Politik mit dem Ziel einer Verbesserung der Studienkultur berücksichtigt werden. Zudem verdeutlicht diese Untersuchung die Notwendigkeit für eine Intensivierung der Fortbildung und die Sensibilisierung für klinische Studien und ihre Bedeutung in der gynäkologischen Onkologie. / The majority of patients diagnosed with ovarian cancer are in an advanced stage of the disease at the time of first diagnosis. Ovarian cancer is the fifth leading cause of cancer death among women. Based on different studies of our working group this postdoctoral lecture qualification ("Habilitation") discussing the value of polymorphism of Il-1 RA (recepetor antagonist gen) as a predisposing factor, the prognostic role of circulating epithelial cells in the peripheral blood and different diagnostic methods (e.g. Cancer Associated Serum Antigens and MRI). Additionally the different cornerstones in the therapeutic management of advanced ovarian cancer are being discussed. First-line treatment of ovarian cancer consists of a radical, often multivisceral surgical approach followed by adjuvant systemic chemotherapy. Treatment options for recurrent ovarian cancer attract special attention. There is evidence that cancer patients treated in clinical trials have significantly better outcomes than patients who are not enrolled in study protocols. In ovarian cancer, engagement in clinical trials is an indicator for the quality of care. However, information about the causes for withholding subjects from entering a clinical trial is sparse. Therefore, a questionnaire containing five different dimensions was sent to all gynecological departments in Germany (with minimum 45 hospital beds). Eligible institutions had not participated in ovarian cancer trials run by either of the two German ovarian cancer study groups. Inadequate infrastructures are the most relevant barriers for gynecological departments in Germany to participate in clinical trials. The reported data underline the need for intensifying continued education, and to strengthen awareness of the importance of clinical trials in gynecologic oncology.

O método INTERMED é um instrumento que classifica a complexidade biopsicossocial de pacientes em diversos níveis de assistência, qualifica o cuidado e melhora a comunicação interprofissional. Ele permite avaliar a complexidade do paciente através da investigação de quatro domínios: biológico, psicológico, social e sistema de saúde. Promove o cuidado integrado com foco no paciente e viabiliza práticas de gestão da clínica e de leitos hospitalares. O objetivo principal desta pesquisa foi realizar a tradução, adaptação transcultural e validação do método INTERMED para realidade hospitalar brasileira. Os objetivos secundários foram avaliar a consistência interna do método, estudar a interface dos resultados do INTERMED com dados sociodemográficos e verificar sua contribuição no gerenciamento de leitos hospitalares e gestão da clínica. O instrumento foi aplicado a um total de 300 pacientes, com mais de 5 dias de internação hospitalar, com idade >=a 21 anos e média de idade de 57,8 anos, sendo que 58,3% eram do sexo masculino. Esta amostra foi coletada entre setembro e dezembro de 2011 em três hospitais da cidade de São Paulo, a saber, um privado (A), um de ensino (B) e um público(C). A validação e adaptação transcultural ocorreram em cinco fases: tradução, síntese, retrotradução, avaliação e validação por um comitê de juízes e pré-teste. A validação da tradução pelo comitê de juízes foi realizada pelo Índice de Validade de Conteúdo e a consistência interna do instrumento foi avaliada pelo coeficiente alpha de Crombach. A estrutura do documento foi estudada pelo Coeficiente de Correlação de Spearman e a validade preditiva para tempo de internação, pela relação entre a pontuação total do score do INTERMED e o tempo de hospitalização dos pacientes. A validação da tradução foi de 94,2% de equivalência semântica, 94,3% equivalência idiomática e 86,6% de equivalência cultural entre o instrumento original e o traduzido. No pré-teste, obteve-se acima de 90% de compreensão em todos os itens do INTERMED. Os scores médios obtidos com o INTERMED foram de 15,20e 21 nas instituições A,B e C respectivamente. Isto significa, pela classificação, do instrumento, que nas três instituições os pacientes não eram complexos (<21 pontos). A consistência interna e precisão do instrumento foram consideradas boa para as três instituições. As correlações entre os domínios do instrumento foram positivas e significantes em sua maioria. Em relação à validade preditiva, tempos maiores de internação foram observados em pacientes com escores maiores. Os dados encontrados sugerem que para além da gravidade biológica, o tempo de internação pode estar relacionado aos aspectos psicológicos, sociais ou do sistema de saúde, como a espera para realização de procedimentos. A versão brasileira do INTERMED possui equivalência com o instrumento original; é confiável, uma vez que os itens do instrumento relacionam-se e são complementares entre si; é válida, pois é capaz de medir o objeto ao qual se propõe. Assim, recomenda-se sua incorporação como uma ferramenta de apoio a gestão de leitos e ao cuidado integral do paciente. / The INTERMED method is an instrument that classifies the biopsychosocial complexity of patients under various levels of healthcare. It also qualifies care and improves interprofessional communication. It also allows us to evaluate patient\'s complexity by means of the investigation of four domains: biological, psychological, social and healthcare. Apart from that, it promotes integrated care by focusing on the patient and by enabling clinical management practices and the availability of hospital beds. The main objective of this research was to translate, transculturally adapt and validate the INTERMED method to the Brazilian health system reality. As a secondary objective, INTERMED aimed at evaluating the internal consistency of the method by studying the interface of the INTERMED results along with sociodemographic data and by verifying its contribution to the availability of hospital beds and clinical management. That instrument was applied to a total of 300 inpatients who had been at hospital for more than 5 days. All of them were 21 years old or more and the average age was 57,8 years old, being 58,3% male patients. That sample was collected between September and December 2011 at three hospitals in São Paulo, being one private (A), one university hospital (B) and one public hospital (C). The validation and transcultural adaptation occurred on five stages: translation, synthesis, back-translation, evaluation and validation by a committee of judges and pre-test. The validation of the translation by the committee of judges was carried out by using the Content Validity Index and the internal consistency of the instrument was evaluated by the alpha Crombach coefficient. The structure of the document was studied by using the Spearman correlation coefficient and the predictive validity for length of stay was evaluated by the ratio between the INTERMED total score and the patients\' length of stay. The validation of the translation reached 94,2% of semantic equivalence, 94,3% of language equivalence and 86,6% of cultural equivalence when the original and the translated document were compared. During pre-test phase, more than 50% of comprehension was achieved in all INTERMED items. The average scores achieved by INTERMED were 15, 20 and 21 at institutions A, B and C, respectively. It means that according to the classification of the instrument at the three institutions patients were not considered complex (< 21 points). The internal consistency and the accuracy of the instrument were regarded as good for the three institutions. In general, the correlation among the domains of the instrument were positive and significant. As regards the predictive validity, longer lengths of stay were observed in patients with higher scores. The data found suggest that besides the biological seriousness, the length of stay may be related to psychological or social aspects or even to the health system in which the time patients wait for procedures may be long. The Brazilian version of INTERMED is equivalent to the original; it is reliable, since its items relate to each other and are complementary among themselves; it is valid, on the grounds that it is able to measure the object it is intended to. Having said that, its use is recommendable as a tool to support the patient\'s integrated care management as well as the availability of hospital beds.

Diante da necessidade de mudança do paradigma do sistema de saúde e uma maior coerência entre o serviço ofertado e as condições de saúde da população, vários países tem buscado a reconfiguração de seus sistemas e/ou novos modelos de organização da gestão. No Brasil, vem sendo instituídas as Redes de Atenção à Saúde (RAS) e como referencial teórico operacional de gestão nesta nova organização se destacam a Gestão da Clínica e a Clínica Ampliada. A Continuidade do Cuidado é um dos elementos principais desse novo paradigma, assim, novos modelos assistenciais surgem em resposta. Os Cuidados Continuados Integrados (CCI) é uma experiência internacional exitosa, de um novo modelo assistencial que se situa nos desenhos de atenção entre o hospital geral e a atenção primária. Está sendo implantado no Brasil, aonde assume a denominação de Cuidados Prolongados e se insere na Rede de Atenção às Urgências e Emergências. OBJETIVO: O presente trabalho tem por objetivo estudar a Unidade de Cuidados Prolongados (UCP), como uma estratégia de atenção no Sistema Único de Saúde (SUS), identificando o processo de trabalho de unidades de um projeto piloto, sob as referências da Gestão da Clínica e da Clínica Ampliada. MÉTODOS: Trata-se de estudo transversal, qualitativo quanto a abordagem, descritivo e exploratório quanto aos objetivos. O trabalho foi elaborado em três etapas complementares, sendo observação (etapa 1), análise de documentos (etapa 2) e aplicação de questionário estruturado composto de 82 assertivas, dividido em 6 blocos temáticos (trabalho em equipe, fluxo do usuário, prática clínica, estrutura / ambiente / materiais, gestão da qualidade e satisfação profissional). O instrumento foi aplicado aos trabalhadores da UCP de dois municípios do Estado de São Paulo (passo 3), que concordaram em participar da pesquisa (N de 26 participantes, 13 de cada unidade em estudo). A análise de dados foi realizada para compreender a organização do fluxo de trabalho e a percepção de trabalhadores e funcionários sobre a instituição, o processo e sua satisfação. A análise das respostas foi realizada calculando a escala média (RM) para a escala de Likert, medindo o grau de concordância dos participantes, em relação ao assertivo. Atribuiuse um valor de 1 (total discordância) a 5 (total concordância) correlacionando as variáveis estudadas intra e interunidades, buscando significação nas variações. RESULTADOS E DISCUSSÃO: foram identificados o desenho assistencial desenvolvido por ambas unidades, desde o referenciamento do usuário de acordo com o modelo de atenção estudado, até seu contra-referenciamento para a atenção básica, além do processo de trabalho e organização da equipe. Através da aplicação do questionário, identificou-se que os profissionais têm a tendencia à satisfação em ii relação aos 6 blocos temáticos (3,1 a 4,3), entretanto com variações significativas em assertivas individuais, em todos os blocos. CONCLUSÃO: O modelo de atenção estudado apresenta evidências de resultados positivos que estão em alinhamento com a literatura estudada, apresentando um design funcional dentro dos princípios do SUS. A articulação deste modelo na RAS ainda é um ponto a ser melhorado. De acordo com as percepções dos profissionais que compõem o trabalho em equipe, devem ser alcançadas melhorias em todos os tópicos estudados, a fim de preencher toda a operação com as propostas de gestão clínica e a clínica ampliada. / Several countries have sought the reconfiguration of their systems and/or new management organization models when faced with the need to change the paradigm of the health system and greater coherence between the delivered services and the health conditions of the population. In Brazil, the establishing of Health Care Networks (RAS) are in course. Clinical Management and the Extended Clinic are the highlights of the theoretical concepts for the operational management of this new arrangement. Continuity of Care is one of the main elements of this new paradigm, so innovative care models emerge in response. Integrated Continuing Care (CCI) is a successful international experience of a novel care model located in the design of care between the general hospital and primary care. It has been implemented in Brazil, denominated by the name of Extended Care and it is part of the Care Network for Urgencies and Emergencies. OBJECTIVE: The aim of this work is to study the Extended Care Unit (UCP), as a care strategy in the Unified Healthcare System (SUS), identifying the workflow of pilot UCP healthcare units, under the references of Clinical Management and Extended Clinic. METHODS: This is a cross-sectional study, with qualitative approach, descriptive and exploratory regarding the objectives. The work was elaborated in three complementary stages, being observation (step 1), analysis of documents (step 2) and application of structured questionnaire composed of 82 assertions, divided into 6 thematic blocks (teamwork, users\' flow, clinical practice, structure / environment / materials, quality management and professional satisfaction). The instrument was applied to UCP workers of two municipalities of the State of São Paulo (step 3), which have agreed to participate of the research (N of 26 participants, 13 of each unit under study). The data analysis was performed in order to understand the organization of the workflow and the perception of workers and staff about the institution, the process, and their satisfaction. Analysis of the responses was performed by calculating the Mean Ranking (RM) for Likert scale, measuring the degree of agreement of the participants, in relation to the assertive. It was assigned values of 1 (total disagreement) to 5 (total concordance) correlating the intra and inter-unit variables studied, seeking significance in the variations. RESULTS AND DISCUSSION: The design of patient assistance carried out by both units were identified, from user referral according to the model of care studied, until their counter-referral for primary care, as well as the workflow process and the team organization. Based on the application of the questionnaire, it was identified that professionals have the tendency to satisfaction in relation to the 6 thematic blocks (3,1 to 4,3), however with significant variations in individual assertives, in each block. iv CONCLUSION: The care model studied presents evidence of positive outcomes that are in alignement with the literature studied, presenting a functional design inside the SUS principles. The articulation of this model in RAS is still a point to be improved. According to the perceptions of the professionals that compose the teamwork, improvements must be achieved in every topic studied, in order to fill the whole operation with the proposals of the clinical management and the extended clinic.