En el presente trabajo expone como tema principal evaluación de la vulnerabilidad sísmica para el diseño del reforzamiento estructural que mejora el comportamiento sismorresistente del hospital Casimiro Ulloa empleando la norma e.030-2014. El objetivo principal planteado es la evaluación de la vulnerabilidad sísmica para el diseño del reforzamiento estructural que mejore el comportamiento sismorresistente del Hospital Casimiro Ulloa empleando la Norma E.030-2014. El diseño metodológico empleado es de tipo cuantitativa explicativa, con un diseño de la investigación es no experimental, transversal y descriptivo. La población y muestra es el Hospital Casimiro Ulloa. Debido a las fallas técnicas, mala distribución de pesos muertos o desgaste de materiales por agentes naturales la lluvia, el viento, sulfatos, entre otros por lo que actualmente no cumple con los parámetros y exigencias de la Norma E-030-2014. El método usado fue la inclusión de muros de corte distribuidos de forma homogénea de tal manera que favorezca a la rigidez en de cada nivel del edificio y a su vez cumpla con los requerimientos especificados en la Norma E-030-2014. Al ser avaluado el Hospital Casimiro Ulloa con la propuesta de reforzamiento de muros de corte se logró cumplir con las restricciones de desplazamientos que plantea la Norma E-030-2014 ampliando la vida útil del Hospital ante alguna eventualidad. In this paper we present the main theme of the seismic vulnerability assessment for the design of structural reinforcement that improves the seismic behavior of Casimiro Ulloa hospital e.030-2014 using the standard. The main stated objective is the evaluation of seismic vulnerability for the design of structural reinforcement to improve the behavior seismic Hospital Casimiro Ulloa using Standard E.030-2014. The methodological design used is of explanatory quantitative type, with a research design is not experimental, transversal and descriptive. The population and sample is Casimiro Ulloa Hospital. Due to technical failures, poor distribution of dead weights or wear natural materials agents rain, wind, sulfates, among others so it currently does not meet the requirements and parameters of the standard E-030-2014. The method used was the inclusion of shear walls distributed evenly so that favoring the stiffness of each level of the building and in turn meets the requirements specified in Rule E-030-2014. To be worth the Hospital Casimiro Ulloa with the proposed strengthening of shear walls it was possible to comply with movement restrictions of the Standard 030-2014 E-extending the life of Hospital before any eventuality.

O objetivo do estudo foi avaliar os níveis de ruído ambiente na unidade de cuidado intensivo neonatal (UCIN) de um hospital universitário de Ribeirão Preto - SP, na perspectiva de buscar sua redução. Trata-se de estudo descritivo, exploratório e observacional estruturado, desenvolvido na UCIN do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, de nível III. A coleta de dados ocorreu em duas etapas: na primeira, dimensionou-se, durante três semanas não consecutivas, o nível de ruído ambiente na UCIN com um dosímetro Quest 400, situado no ponto central da enfermaria que comporta 10 leitos; na segunda etapa, realizou-se o inventário do ruído para detecção das fontes de ruídos intensos, registrando-se as observações (08 a 14/05/2004 das 7 às 19h) em um check list. A intensidade do ruído variou de 48,6dBA (Lmin) a 114,1dB (Lpeak), ficando o menor e o maior Leq entre 49,9dBA e 88,3dBA, respectivamente. A média de Leq na primeira semana foi de 64,0dBA, na segunda, de 62,5dBA e de 63,2dBA na terceira. O Lmax diário variou de 81,4 a 94,2dBA, sendo que na primeira semana registrou 92,5dBA; na segunda, 89,9dBA e 94,2dBA na terceira. O menor e o maior Lpeak foram de 105,7 e 114,1dB, respectivamente, integralizando 114,1dB na primeira semana, 112,6dB na segunda e 112,7dB na terceira. O Lmin diário variou de 48,6 a 54,1dBA, sendo maior na primeira semana de coleta em comparação às demais. O L10 foi de 67,0; 65,0 e 66,0dBA, respectivamente, na primeira, segunda e terceira semanas. A partir do inventário do ruído, verificou-se que maior número de pessoas circulando na UCIN, tonalidades altas da voz nas conversas, a presença de alarmes estridentes, a manipulação não cuidadosa ao fechar armários/gavetas/tampas de lixo/portas, alto fluxo da água da torneira do lavabo e quedas de objetos foram geradores de ruídos intensos. Concluiu-se que o ruído na UCIN foi intenso em todos os dias de coleta de dados, estando acima das normas técnicas e recomendações internacionais, fato também constatado em outros estudos. Recomenda-se para a redução do ruído em UCIN trabalhar de forma interdisciplinar e intersetorial, intervindo junto à equipe de saúde, clientela, ambiente físico e equipamentos. / El objetivo de este estudio ha sido evaluar los niveles de ruido ambiente en la unidad de cuidado intensivo neonatal (UCIN) de un hospital universitario de Ribeirão Preto - SP, ante la perspectiva de buscar su reducción. Se trata de estudio descriptivo, exploratorio y observacional estructurado, desarrollado en la UCIN del Hospital de Clínicas de la Facultad de Medicina de Ribeirão Preto de la Universidad de São Paulo, de nivel III. La recolección de datos ocurrió en dos etapas: en la primera, se dimensionó, durante tres semanas no consecutivas el nivel de ruido ambiente en la UCIN, con un dosímetro Quest 400, situado en el punto central de la enfermería que comporta 10 lechos; en la segunda etapa, se realizó el inventario del ruido para detección de las fuentes de ruidos intensos, registrándose las observaciones (08 a 14/05/2004 desde las 7 hasta las 19h) en un check list. La intensidad del ruido varió de 48,6dBA (Lmin) a 114,1dB (Lpeak), quedando el menor y el mayor Leq entre 49,9dBA y 88,3dBA, respectivamente. El promedio de Leq en la primera semana fue de 64,0dBA, en la segunda, de 62,5dBA y de 63,2dBA en la tercera. El Lmax diario varió de 81,4 a 94,2dBA, siendo que en la primera semana registró 92,5dBA; en la segunda, 89,9dBA y 94,2dBA en la tercera. El menor y el mayor Lpeak fueron de 105,7 y 114,1dB, respectivamente, constatándose 114,1dB en la primera semana, 112,6dB en la segunda y 112,7dB en la tercera. El Lmin diario varió de 48,6 a 54,1dBA, siendo mayor en la primera semana de recolección en comparación con las otras. El L10 fue de 67,0; 65,0 y 66,0dBA, respectivamente, en la primera, segunda y tercera semanas. A partir del inventario del ruido, se verificó que mayor número de personas circulando en la UCIN, tonalidades altas de voz en las conversaciones, la presencia de alarmas estridentes, la manipulación no cuidadosa al cerrar armarios/gavetas/tapas de cubos de basura/puertas, alto flujo de agua de la canilla/grifo del lavabo y caídas de objetos fueron generadores de ruidos intensos. Se concluyó que el ruido en la UCIN fue intenso en todos los días de recolección de datos, estando arriba de las normas técnicas y recomendaciones internacionales, acto también constatado en otros estudios. Se recomienda para la reducción del ruido en UCIN trabajar de forma interdisciplinaria e intersectorial, interviniendo con el equipo de salud, clientela, ambiente físico y equipamientos.

O estudo teve como objetivo identificar os estilos de liderança exercidos pelos profissionais de enfermagem com cargos diretivos e sua relação com os traços de conduta tipo A e a maturidade dos colaboradores sob sua direção. O universo esteve composto por enfermeiros diretivos de cinqüenta hospitais gerais da cidade de México, Distrito Federal, sendo tomado como referencial teórico o modelo de liderança situacional de Hersey e Blanchard e a Teoria de Conduta de Friedman e Rosenman. Foi testada a hipótese de relação significante entre os estilos de liderança exercidos pelos profissionais com cargos diretivos e seus traços de conduta tipo A e os tipos de maturidade de seus colaboradores. O estudo é de caráter quanti-qualitativo. Os resultados quantitativos mostraram que os profissionais com cargos diretivos exercem diferentes estilos de liderança. Os valores de correlações foram S1 R2 0,14 dos profissionais exercem a liderança diretiva (alta preferência pelas tarefas e baixa preferência pelas relações interpessoais), S2 R2 0,59 o estilo persuasivo (alta preferência pelas tarefas e alta preferência pelas relações interpessoais), S3 R2 0,27 o estilo participativo (alta preferência pelas relações interpessoais e baixa preferência pelas tarefas) e S4 R2 0,21 o estilo delegativo (baixa preferência pelas tarefas e baixa preferência pelas relações interpessoais). A maturidade inativa, foi observado um coeficiente de correlação de R1 R2 0.14 dos participantes (baixa disposição e baixa habilidade para as tarefas); R2 R2 0,51 apresentou maturidade reativa (baixa disposição e alta habilidade para as tarefas), R3 R2 0,18 maturidade pró-ativa (alta disposição e baixa habilidade para as tarefas) e R4 R2 0,14 a maturidade interativa (alta disposição e alta habilidade para as tarefas). Em uma escada de 0 a1, a qualificação media para os traços conduta tipo A mostraram Os 74% dos profissionais com cargos diretivos. Os resultados qualitativos indicam que esses profissionais percebem um ambiente de trabalho burocrático, com características típicas de organização e regulamentação, comunicação, e hierarquia orientada ao alcance dos objetivos. O alto grau de exigência é observado na sobrecarga de trabalho, o 81% dos diretivos cumprem com jornadas de trabalho diário de mais oito horas e 64% desses diretivos têm sob sua responsabilidade entre 400 e 500 trabalhadores. Outro indicador qualitativo é o período de permanência no cargo diretivo, variando entre um a dez anos para os 81%, e a tendência à continuidade do preparo acadêmico: 62% com grau de licenciatura e 24% com pós-graduação. Conclui-se que os diretivos alcançam as metas propostas com diferentes estilos de liderança que visam a estimular os enfermeiros, que mostram estar preparados, mas com problemas de motivação. Os diretivos utilizam estratégias de persuasão para obter a colaboração dos seguidores. Na situação analisada, se cumpre o modelo Hersey e Blanchard e oferece importantes pontos de vista para o fortalecimento da liderança em enfermagem nos hospitais gerais da cidade de México, Distrito Federal. / The main objective of this study is identify the styles of leadership exercised by directive nurses at general hospitals of Mexico City, according to situational leadership model of Hersey and Blanchard and its relationship with features type \"A\" of the leaders and the degrees of the maturity of their collaborators, according to behavior theory of Friedman and Rosenman. The study is quant-qualitative and was done with cooperation of directive nurses at the mentioned hospitals. The quantitative results demonstrated four leadership styles exercised by directive nurses: directive style characterized by its high preference for the tasks and low preference for the interpersonal relationships, persuasive style characterized by its high preference for the tasks and high preference for the interpersonal relationships, participant style characterized by its high preference for the relationships interpersonal and low preference for the tasks and delegatory style characterized by low preference for the tasks and low preference for the interpersonal relationships. The directive nurses apply the directive style in coefficient determination R2 0,14 of their decisions, the persuasive style in R2 0,59, the participant style in R2 0,27 and the delegatory style in R2 0,21 of their decisions. The followers showed four grades of readiness for the execution of their tasks: coefficient determination, inactive R2 0,14 attitude characterized by their low disposition and low ability for the tasks, reactive R2 0,51 attitude characterized by its low disposition and high ability for the tasks, attitude pre-active R2 0,18 characterized by its high disposition and low ability for the tasks and interactive R2 0,14 attitude characterized by its high disposition and high ability for the tasks. The directive nurses showed features of behavior type A in 74% of the cases. The qualitative results indicate that the directive ones perceive a mechanicbureaucratic orientation of the hospitals, with their typical characteristics of norms, communication, functions and hierarchy, total orientation to the achievement of the objectives, emphasis in the tasks and routine processes. The high demand is reflected in the work overload that they experience. In 81% of cases they work more than eight daily hours, 64% supervises between 400 and 500 professionals of the health and 81% abandon their positions after 10 years. The directive personnel has tendency toward the academic advance. 62% has degree grade and 24% has postgraduate. The directive nurses achieve the goals of the organization by means of the combination of four styles of leadership to influence in their followers; most of them are well qualified but have motivation problems. The directive nurses apply, frequently, the persuasive style of leadership which is related with the reactive attitude of the followers. They solve the personnel\'s deficiencies with excessive work loads. To conclude, the pattern of situational leadership of Hersey and Blanchard is useful to diagnose the situation of the leadership of the nurses and to identify the aspects to be strengthened in the general hospitals of the city of Mexico D. F.

Esta dissertação aborda a escrita enquanto experiência em que vida e pensamento se engendram mutuamente. Integra o grupo de pesquisa “Potência Clínica das Memórias da Loucura”, que se dá junto à Oficina de Criatividade do Hospital Psiquiátrico São Pedro, e que se ocupa, em parte, com a escrita da vida de alguns internos. Escreve-se, portanto, através da aproximação com certa vida em risco e arriscada, que lança linhas de criação e sobrevivência de si em um mundo que está, para todos os efeitos, arrematado. Assim, a escrita traça contornos no encontro com a linguagem em desrazão, a qual busca, sem encontrar, um ponto de ancoragem. É na afirmação de uma diferença que está o espaço de um percurso de experimentação. / This thesis approaches the writing as an experience in which life and thought engender themselves mutually. It integrates the research group “Clinical Potency of the Memories of Madness”, which happens along with the Creativity Workshop of the Psychiatric Hospital São Pedro, working, in part, with the writing of the life of some patients. It is written, therefore, by an approach to a certain risky and at stake life, which launches lines of creation and survival of oneself in a world that is, for all intents and purposes, finished. Therefore, the thesis draws borders when meeting with the language in unreason, which seeks, without finding, an anchor point. It is in the affirmation of a difference that is the space of a journey of experimentation.

A área de enfermagem tem vivenciado algumas problemáticas relativas a recursos humanos, entre elas: escassez de enfermeiros, insatisfação no trabalho e alta rotatividade nos serviços.Este estudo descritivo teve como objetivos: descrever a distribuição das diferentes categorias de trabalhadores de enfermagem segundo variáveis demográficas e de inserção no emprego na rede hospitalar do município de Uberaba-Minas Gerais; mensurar e descrever a rotatividade desses trabalhadores. O estudo foi realizado em 11 hospitais, sendo um público, seis privados e quatro filantrópicos. A população constituiu-se de todos os enfermeiros, técnicos e auxiliares de enfermagem que, no período de 1º de janeiro a 31 de dezembro de 2003, antiveram vínculo empregatício nos hospitais estudados. As variáveis demográficas estudadas foram: sexo e idade; aquelas de inserção no emprego: regime de contrato, jornada semanal, tempo de trabalho e rendimento médio. A rotatividade foi verificada aplicando-se indicadores globais: taxas de admissão (TA) e de desligamento (TD), taxa líquida de substituição (TLS), permanência média no emprego (em anos); e específicos: tempo mediano de trabalho dos demitentes (em meses) e curva de sobrevivência no emprego. Os dados foram coletados mês a mês, em fontes secundárias originárias do cadastro de empregados e folha de pagamento. Durante o ano de 2003 estiveram empregados na rede hospitalar 1.368 trabalhadores de enfermagem, sendo 805 auxiliares de enfermagem, 417 técnicos de enfermagem e 146 enfermeiros. Essa força de trabalho era composta, majoritariamente, por mulheres (81,8%), com idade mediana de 38 anos, a maioria cumprindo jornada de trabalho semanal de 36 horas, sob contrato celetista. Nos hospitais privados e filantrópicos os trabalhadores eram mais jovens que no público; 70% dos técnicos de enfermagem, 60% dos auxiliares de enfermagem e 50% dos enfermeiros tinham menos de cinco anos no emprego atual. Os enfermeiros apresentaram média de rendimentos de 5|-10 SM e os técnicos e auxiliares de enfermagem, de 2|-5 SM. Nos hospitais estudados ocorreram 327 admissões e 276 demissões. As taxas de admissão dos trabalhadores (31%) foram superiores às de desligamento (26,1%). Os hospitais privados apresentam as maiores TA (44,3%) e TD (42,1%). A TLS dos trabalhadores foi de 24,3%. O maior nível de TLS situou-se nos hospitais privados (30,7%). O quadro de trabalhadores da rede hospitalar seria totalmente renovado em 3,6 anos; nos hospitais privados, isso ocorreria em 2,4 anos enquanto no público, em 5,3 anos. Todos os enfermeiros seriam substituídos em 4,7 anos e os técnicos e auxiliares de enfermagem em, aproximadamente, 3,5 anos. A mediana de tempo de trabalho dos 276 trabalhadores que saíram do emprego foi de 19 meses; para os demitentes do hospital público, esse tempo foi de 37 meses; nos hospitais privados, de 13 meses, cerca de um ano; pelas curvas de sobrevivência no emprego dos demitentes, identificou-se maior estabilidade e, por conseqüência, menor rotatividade para o grupo de trabalhadores do hospital público. De modo geral, a rotatividade nos hospitais estudados pode ser considerada elevada. Os resultados do estudo trazem contribuições importantes, tanto à direção dos hospitais e serviços de enfermagem, como ao gestor local com vistas ao gerenciamento de recursos humanos em enfermagem no município. / The Nursing area has been facing some difficulties regarding the human resource aspects like nurse scarceness, work dissatisfaction, high turnover rate. The present report aims to describe the allocation of the different Nursing working categories according to demographic variables and working admittance in the hospital network staff of Uberaba - Minas Gerais; to evaluate and portray the turnover of these professionals. The study had embraced eleven hospitals, including a public one, six privates and four philanthropics. The large sample is composed by every Nurse, Technician and Nurse Assistant that had employment relationships with the hospitals aforementioned, in the period of January, 1st to December, 31st of 2003. The demographic variables analyzed were: gender and age; regarding the working admittance: labor agreement, weekly working journey, average income. The turnover was evaluated using global indexes: admission (TA) and dislodgment (TD) rate, liquid replacement rate (TLS), stayers mean service (by years); and specifics: leavers mean service (months), and survival of leavers curve. The data were acquired monthly, using secondary sources, derived from Employees Official Register and Payroll. During 2003, the hospital network engaged 1368 Nursing employees, including 805 nursing assistants, 417 nursing technicians and 146 nurses. This working power was compounded mostly by women (81,8%), with ages varying from 38 years, the majority with 36 hours weekly work journey, under usual rules agreement. The workers are younger in the private and philanthropic hospitals than in the public ones; 70% of nursing technicians, 60% of nursing assistants and 50% of nurses have been less than 5 years in the present work. The nurses have average income of 5 to 10 minimum salaries and the nursing auxiliaries and technicians have 2-5 minimum salaries. In the aforementioned studied hospitals occurred 327 admissions 276 resignations. The admission rate (31%) was higher than the resignation rate (26,1%). The private hospitals presented the biggest TA (44,3%) and TD (42,1%). The TLS was 24,3%. The TLS highest rate is on the private hospitals (30,7%). The entire employee staff would be completed renewed on 3,6 years; in the private hospitals this situation would happen in 2,4 years, while the public would take 5,3 years. All the nurses would be replaced in 4,7 years and the nursing assistants and technicians in 3,5 years. The median service of the 276 workers who left the job were 19 months; for the leavers of the public hospital this time were of 37 months; in the private hospitals, 13 months, approximately a year; by the survival leavers curve could be identified a higher work stability rate, therefore lower turnover rate in the public hospitals. In general, the turnover in the studied hospitals can be considered high. When the issue is the management of human resources in nursing, the results of the study bring important contributions, as much to the hospitals’ direction and nursing services, as to the local manager in town.

Introdução: As feridas agudas e crônicas provocam alterações físicas, psíquicas, sociais e econômicas para o indivíduo e família. Embora bem estabelecidos os dados epidemiológicos sobre essas lesões no contexto internacional, ainda são incipientes no Brasil, principalmente na Região Amazônica. Objetivo: Identificar e analisar a prevalência e fatores demográficos e clínicos associados à ocorrência de algumas feridas agudas e crônicas (Lesão por Fricção LF, Dermatite Associada à Incontinência DAI, Ferida Operatória Complicada FOC, Lesão por Pressão LP e Úlcera Diabética - UD) em pacientes hospitalizados. Métodos: Trata-se de estudo epidemiológico, observacional, transversal, analítico e descritivo, realizado em sete hospitais da cidade de Manaus. Os dados foram coletados por meio de consulta aos prontuários, entrevistas com os pacientes ou responsáveis legais e exame físico de todos os pacientes internados, durante o período de março a junho de 2015. As lesões encontradas foram avaliadas utilizando-se os seguintes instrumentos: Sistema de Classificação STAR - Lesão por Fricção para as LF; Incontinence Associated Dermatitis Intervention Tool (IAD-IT) para DAI; Pressure Ulcer Scale for Healing PUSH pernas, para FOC, Pressure Ulcer Scale for Healing PUSH UP para LP e Classificação de Wagner para as UD. Ademais, instrumento para levantamento dos dados sociodemográficos e clínicos e a Escala de Braden também foram empregados. Os dados foram analisados por meio de: teste Qui-quadrado ou exato de Fisher para as variáveis categóricas e teste t para as numéricas. Modelo de árvore de decisão com o algoritmo Classification and Regression Tree (CART) foi utilizado para identificação dos fatores associados à presença das feridas, de maneira simultânea e isolada. Resultados: A amostra (n=775) foi predominantemente do sexo masculino (457/ 58,9%), com média de idade de 60,4 anos (DP=18,7) raça parda (240/30,9%); situação conjugal com companheiro (413/53,2%) e ensino fundamental (403/52,0%). Cento e setenta e oito pacientes apresentaram lesões durante a coleta de dados, acarretando prevalência pontual global de 23%. Com média de 1,1 ferida (DP=0,4) por paciente, predominaram as LP (n=80/ 10,3%), seguidas de UD (n=66/ 8,5%). Os demais tipos de feridas mostraram prevalências de 2,7% (n=21) para FOC; 0,9% (n=7) para LF e 0,5% (n=4) para DAI. A maior ocorrência das lesões quanto às regiões corporais foram o dorso da mão E para a LF; região dos grandes lábios para DAI; perna E para FOC; região sacra para LP e: planta do pé E para UD. O CART mostrou Diabetes Mellitus, uso de anticoagulante, presença de rigidez, escore de Braden sem risco (>18), presença de curativo e de hematoma como os fatores associados à presença de todas as feridas, de forma simultânea, repetindo-se algumas dessas condições para LP e UD. Conclusão: O estudo, inédito na região amazônica, possibilitou um diagnóstico mais acurado da epidemiologia de algumas das mais importantes e prevalentes feridas agudas e crônicas, em pacientes hospitalizados, como a LF (0,9%), DAI (0,5%), FOC (2,7%), LP (10,3%) e UD (8,5%). Com prevalências pontuais inferiores à maioria dos resultados de estudos nacionais e internacionais, o estudo suscita a necessidade de mais investigações na região, particularmente estudos de incidência, mesmo que a maioria dos fatores associados constatados nos pacientes hospitalizados amazonenses esteja também presente na literatura. / Introduction: Acute and chronic wounds provoke physical, psychological, social and economic changes for individuals and their families. While, in an international context, epidemiological data regarding these wounds and lesions is well established, it is still in an incipient stage in Brazil, particularly in the Amazon Basin Region. Objective: To identify and analyze the prevalence and demographic and clinical factors associated with the occurence of several acute and chronic wounds (frictional lesions - frictional keratosis, incontinence-associated dermatitis - IAD, post-operative wound complications, pressure sores and diabetic ulcers) in hospitalized patients. Methods: This is an observational, transverse, analytical and descriptive epidemiological study conducted in seven hospitals in the city of Manaus. The data was collected by consulting hospital records, interviews with patients or legal guardians and physical examinations of all hospitalized patients, during the period from March through June 2015. The lesions found were evaluated using the following instruments: Classification System STAR -- Frictional Lesion for frictional lesions; Incontinence Associated Dermititis Intervention Tool (IAD-IT) for IAD; Pressure Ulcer Scale for Healing - PUSH UP for pressure sores and Wagner Classification for diabetic ulcers. Moreover, an instrument for socio-demographic and clinical data collection and the Braden Scale were also employed. The data was analyzed by way of the Chi-squared distribution test or T-Test for numerical ones. The decisionmaking tree model using the Classification and Regression Tree (CART) algorithm was utilized in the identification of factors associated with the presence of lesions, simultaneously and in isolation. Results: The study sample (n=775) was predominantly of the male sex (457 / 58,9%) with an average age of 60.4 years (DP=18.7) mulatto (240/30.9%); marital situation with spouse (413/53.2 %) and elementary school complete (403/52.0%). One hundred and seventy-eight patients presented lesions during the datacollection period, leading to an overall point prevalence of 23%. With an average of 1.1 lesions (DP=0.4) per patient, pressure sores predominated (n=80/10.3%), followed by diabetic ulcers (n=66/8.5%). The remaining types of lesions showed a prevalence of 2.7% (n=21) for post-operative wound complications; 0.9% (n=7) for frictional lesions and 0.5% (n=4) for incontinence associated dermititis (IAD). The primary occurence of lesions to particular parts of the body were frictional lesions to the back of the left hand; incontinence associated dermititis lesions to the region of the outer labia; post-operative wound complications to the left leg; pressure sores to the sacrum; and diabetic ulcers to the sole of the left foot. CART showed Diabetes Mellitus, the use of anticoagulants, the presence of rigidness, the Braden score without risk (>18), the presence of bandages and bruises as factors simultaneously associated with the presence of lesions, repeating some of these conditions for pressure sores and diabetic ulcers. Conclusion: The study, unprecedented in the Amazon Basin region, made a more accurate epidemiological diagnosis possible of some of the most important and prevalent acute and chronic lesions in hospitalized patients, such as frictional lesions (0.9%), IAD (0.5%), post-operative wound complications (2.7%), pressore sores (10.3%) and diabetic ulcers (8.5%). With point prevalences inferior to the majority of national and international studies, despite the fact that the majority of the associated factors found in hospitalized Amazonian patients are the same as those present in a review of the literature, this study evokes the need for more investigation throughout the region,.particularly incidence studies.

Isolation of those ill with contagious disease has been a fundamental infection control concept for hundreds of years. However, recent studies suggest that fewer than 50% of health—care workers comply with their hospitals' isolation precaution policies and that efficacy of some of those policies is questionable. In response, two new systems, based upon fundamentally different goals, were promoted. The Centers for Disease Control, prompted by health—care worker& concerns about occupational risk of human immunodeficiency virus (HIV) from a growing number of patients with acquired immunodeficiency disease syndrome (AIDS), issued formal guidelines in 1987. This formed the basis for Universal Precautions (UP), a unifying strategy for precautions with all patients regardless of diagnosis intended to reduce risk to hospital staff members. Also in 1987, one hospital issued guidelines for Body Substance Isolation (BSI), hygienic precautions to be used with all patients based on recognition that colonized body substances are important reservoirs for cross—infection to both patients and staff members. These new strategies have been promoted widely, but there have been no formal assessments to reconcile controversies they raised nor to confirm their effectiveness. Further, necessary assessment tools have not been validated. This thesis provides new tools and new information to address three vital questions: Have hospitals adopted Universal Precautions or Body Substance Isolation? Do their staff members use the new system of precautions in daily practice? Has reliable use of a new system led to decreased risk of infection? A confidential mailed survey of all acute—care Canadian hospitals was conducted to measure rates of guideline receipt and adoption. It also obtained information on motivations for and perceived effectiveness of strategies adopted. A self—selected group of responding hospitals subsequently participated in standardized covert observation of their nurses infection control practices, then had the observed nurses complete a test examining their knowledge and beliefs. Employee health records were also examined to determine whether needlestick injury rates had changed since adoption of a new infection control strategy. Most Canadian hospitals adopted and modified new strategies based upon reasonable but unproven extensions of logic to protect health—care workers from HIV. 74% claimed UP (65%) or BSI (9%) but only 5% of 359 claiming UP and 0 of 50 claiming BSI adopted all policies expected. Many hospitals had not received key guideline publications. Guideline source, hospital size, and other variables were significantly associated with receipt. Nurses in 35 hospitals were observed to wear gloves during only z60% of procedures in which gloving was expected; rates varied widely among hospitals. Direct examination of sharps disposal containers confirmed compliance with a policy to not recap used needles (taken as recapping rate of 25%) in only 47% of 32 hospitals. Paired analysis of needlestick injury rates in 11 hospitals during comparable 90—day periods before versus after implementing UP/BSI showed no significant difference. 489 nurses completing a written test achieved their highest scores and least discordance among questions regarding procedural issues established long before UP/BSI, and lower scores or greater discordance on UP/BSJ concepts of philosophy, risk recognition and newer procedures. Positive correlation between knowledge and practice was not evident. UP and BSI now mean different things in different hospitals and have not been effective in harmonizing health—care workers’ infection control practices. Carefully standardized assessment methods are needed to guide their evolution to cost—effectiveness. / Graduate and Postdoctoral Studies / Graduate

There are many examples in the literature of conventional or traditional drug distribution systems in hospitals which possess many shortcomings with reference to medication errors, the amount of time spent by nursing personnel in medication-related duties, inventory losses, the preparation of intravenous admixtures, and the lack of adequate drug usage records. These deficiencies primarily are due to the pharmacist's minimal influence over the control of the traditional drug distribution systems. An analysis and evaluation of the present pharmacy services at St. Paul's Hospital, Vancouver, B.C., similarly identified a traditional distribution system subject to many of the aforementioned potential problems. Using information based on existing unit dose systems as reviewed in the literature and data collected from a general questionnaire, new pharmacy services based on unit dose drug distribution are projected for St. Paul's Hospital. The required facilities and personnel for a progressive unit dose drug distribution system, an intravenous (I.V.) admixture preparation service and a drug surveillance program are projected accordingly. It would appear that a "centralized" approach to implementing unit dose distribution is most appropriate for St. Paul's Hospital's present requirements. This would involve the preparation and distribution of all drugs to nursing units in single dose packages from a central pharmacy area. A similarly centralized intravenous admixture service and a decentralized drug surveillance program also are described. These services commonly feature a greater responsibility being placed with the pharmacy department for preventing therapy problems such as admixture incompatibilities, drug interactions, adverse drug reactions and inappropriate drug selection. The effect of the above services on the responsibilities and number of pharmacy and nursing personnel is estimated based on results in similar programs. These changes also reflect extended hours of coverage in each area. Finally, a potential phasing plan and time schedule for the implementation of the proposed unit dose drug distribution system, I.V. admixture preparation service and drug surveillance program at St. Paul's Hospital is suggested. / Pharmaceutical Sciences, Faculty of / Graduate

The objective of this research is to develop a simulation model as an aid in planning hospital operations. The hospital pharmacy is selected as an appropriate area for study. An extensive systems analysis of pharmacy functions is undertaken. A simulation model of the inpatient dispensary operations is developed using the IBM General Purpose Simulation System. This model allows experimentation with dispensary work-load, operations, and manpower schedule. Statistics are provided on service to the patient, work-load distribution, and manpower utilization. Variation in pharmacist availability and type of prescription entering the dispensary allows optimization of operations. Several experiments are conducted to illustrate the model concept and experiment possibilities. It is concluded that the model is a valuable planning tool for the hospital pharmacy administrator and can be extended to simulate operations in other areas of the pharmacy. / Business, Sauder School of / Graduate

The purpose of the present study was to examine some of the relationships between the level of performance and job satisfaction, goal perceptions, and value of rewards. The subjects for the study were the department managers and nursing supervisors of a small general hospital. Performance criteria for the subjects were obtained by convergent and discriminant analysis of superiors' ratings on a number of traits. The data obtained, indicated that the two groups of subjects, although working in the same organization, had quite dissimilar attitudes and perceptions. The findings were interpreted as manifestations of the different organizational micro-climates in which the two groups operated. / Business, Sauder School of / Graduate