Much of literature is predicated upon the assumption that learning occurring inside the workplace is related to developing expertise associated with the tasks for which the individual is employed and has a background in. This research investigates those individuals who acquire expertise in other disciplines and how the application of that additional expertise changes and enhances the individual and the organisation. By combining perspectives across the disciplinary boundaries and developing multidisciplinary expertise, these individuals demonstrate better methods of achieving business objectives, leading to faster, more imaginative solutions, more frequently, and with significantly less effort. The literature review commenced with defining “multidisciplinary” before addressing communities that cluster around disciplines such as professional societies and Communities of Practice, Aspects of organisational, team and “learning by participation” (Ashton, 2004) literature were also considered. The study took an inductive approach using an ethnographical perspective to data collection and analysis to achieve its aim of determining the existence of multidisciplined individuals and how they acquire additional disciplines. The study used interviewing as its primary method yielding both qualitative and quantitative data from a cross sectional sample set inside a medium sized oil and gas consultancy offering technical and management advice. The disciplines inside the case organisation were mapped to ascertain boundaries where the richest learning opportunities lie. Measuring learning across the disciplines confirmed the existence of multidisciplined individuals with evidence pointing towards the integrated multidisciplined team being the ideal learning environment. The study was able to use Threshold Concepts (Meyer and Land, 2003) to demonstrate the multidisciplinary individual development process. Moreover, having examined the social interaction learning processes the potential negative impacts of Communities of Practice in encouraging this type of multidiscipline approach was highlighted. The study concluded that developing multidisciplined individuals was worthwhile but required organisations to be willing to provide the appropriate platform for such learning by more adventurous individuals who held the appropriate underlying abilities required by the additional discipline (s).

Visualization of digital geographic data is often accomplished through custom symbology that is saved in a proprietary format called a layer file (.lyr). The sharing of free geographical information system (GIS) data can be limited as the symbology data is bound inthe .lyr file format. This makes it harder and more tedious to work with open software tools since it is not possible to convert or open the .lyr file in free and open GIS software and thus limits the distribution of free GIS data. The aim of this thesis is to increase the interoperability of .lyr data between proprietary and free and open GIS software. This was done by revers eengineering the .lyr file format to document the file structure and to distribute the knowledge and metadata gained from this project to the open source community. Reverse engineering the.lyr format provided a well needed metadata and documentation about the format which increases the interoperability and enable future work to continue to lessen the gap between open source and commercial software. This groundwork can therefore, enable a continued development of data interoperability between proprietary and free and open GIS software.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

The theoretical part of this diploma thesis aims to summarize the basic information about rehabilitation of a family as a relatively new phenomena in Czech social work with families. Firstly I describe according to a disposable literature functions of a family, its importance to a child as well as the most common problems a family can face. Than I place rehabilitation of a family as an approach into the Czech system of care of vulnerable children and describe disadvantages of the current system. Lastly I decribe the characteristics of rehabilitation of a family as a multidisciplinary approach to family social work. The empirical part of this thesis is based on semi-structured interwievs with profesionals in the field of rehabilitation of a family as well as clients of family rehabilitation services. It aims to find out how can we use educational activities when working with families in danger of social failure. KEY WORDS: family rehabilitation, multidisciplinary approach, families in danger of social failure, case conference Powered by TCPDF (www.tcpdf.org)

Bakgrund: Den svårt skadade traumapatienten kräver ett multidisciplinärt och tvärprofessionellt omhändertagande vid ankomst till akutmottagningen. En av anestesisjuksköterskans arbetsuppgifter är att delta i omhändertagandet av traumapatienter. Detta kräver att anestesisjuksköterskan kan arbeta i ett anpassat arbetstempo samt kunna arbeta tvärprofessionellt i en stressad miljö. Rött traumalarm ökar kraven på anestesisjuksköterskan som skall inneha fördjupade medicinska- och omvårdnadskunskaper vid omhändertagandet av traumapatienter. Syfte: Studiens syfte var att belysa hur anestesisjuksköterskor upplevde deltagandet vid rött traumalarm. Metod: En kvalitativ design användes och besvarades med semistrukturerade intervjuer. Studien innefattade tio anestesisjuksköterskor från två mellanstora sjukhus i södra Sverige. Intervjuernas datamaterial analyserades med hjälp av en kvalitativ latent innehållsanalys. Resultat: Anestesisjuksköterskor i studien beskrev ett engagemang till det akuta omhändertagandet samt en vilja till att leverera en kvalitativ vård. Traumaomhändertagandet upplevdes ibland som utmanande, framförallt om det var flertalet skadade eller om patienten var svårt skadad. Samtidigt beskrevs ett ansvar över att vara en resurs för teamet och en länk för patienten under omhändertagandet. Struktur och trygghet var viktiga faktorer till ett lyckat teamsamarbete. För att arbetet kring patienten skulle ske på ett systematiskt och patientsäkert sätt, betonade anestesisjuksköterskorna vikten av utbildning inom traumasjukvård. Slutsats: Anestesisjuksköterskans deltagande i rött traumalarm kräver god kunskap inom såväl traumasjukvård som förmågan till samarbete och kommunikation. Kommunikation och samarbete visade sig oftast fungera väl, men då brister uppstod påverkades traumaomhändertagandet negativt, vilket även innefattade patientsäkerheten. Studien visar att traumaledaren har en avgörande betydelse gällande teamets förmåga till ett lyckat traumaomhändertagande. / Background: The severely injured trauma patient requires a multidisciplinary and interdisciplinary medical care on arrival to the emergency department. One of the nurse anaesthetists tasks is to participate in the care of trauma patients. This requires that the nurse anaesthetists can work in an adapted pace of work and be able to work interdisciplinary in a stressed environment. Red-trauma emergency increases the demand for nurse anaesthetist who shall hold in-depth medical and nursing skills in the care of trauma patients. Objective: The aim of this study was to illustrate the nurse anaesthetist experiences of taking part in red-trauma alarm. Method: The study had a qualitative approach and was answered by semi-structured interviews. The study included ten nurse anaesthetists from two middle large hospitals in southern Sweden. The data from the interviews were analyzed by using a qualitative latent content analysis. Results: Nurse anaesthetists in the study described an attraction to the acute care and a desire to deliver quality care. Trauma care perceived sometimes as challenging, especially if it was the most damaged, or if the patient was seriously injured. At the same time the nurse anaesthetists described a responsibility as being a resource for the team and a link to the patient during care. Structure and security were important factors in a successful team collaboration. So, that the work around the patient would be done in a systematic and patient safely, the nurse anaesthetists emphasize the importance of education in trauma care. Conclusion: The nurse anaesthetist attending in red-trauma emergency requires good knowledge in both trauma care as the ability to co-operation and communication. Communication and co-operation shown to usually work well, but when the deficiencies arose impacted negatively trauma care, which also included patient safety. The study have shown that the trauma leaders expertise have an essential role for a successful trauma-care.

The primary objective of the current study was to attempt to establish whether there is a need for a dysphagia training programme for nurses and speech-language therapists working with acute tracheostomised patients in critical care units in South Africa. The research design that was adopted for this project was within a mixed methods approach framework. An exploratory descriptive survey design using semi-structured face-to-face interviews was used. The final sample consisted of interviews with 20 speech-language therapists from eight different hospitals with critical care facilities and 12 nurses from four different hospitals with such facilities. Data from the close ended questions were analysed using descriptive statistics, while remaining data from open ended questions were thematically analysed and the constant comparison method was applied. The data demonstrated that all speech-language therapists and 10 out of the 12 nurses were in agreement that there was a need for a dysphagia training programme for nurses in critical care for tracheostomised patients presenting with dysphagia. An important and unexpected result of this study was that speech-language therapists themselves required additional training in this area. The data demonstrated that the majority of speech-language therapists and nurses were of the view that they had received minimal theoretical and practical hours on tracheostomy screening, assessment and management at an undergraduate level. Overall, the results of the current study suggested varied practices in the screening, assessment and management of tracheostomy and dysphagia, particularly with regard to blue dye testing, suctioning protocols and cuff inflation and deflation protocols. The research significance and implications of the study included the need to improve undergraduate training for speech-language therapists and nurses in the area of dysphagia and tracheostomy, to alert professional training bodies regarding institution of additional licensing and qualifications for speech-language therapists and nurses in the area of dysphagia and tracheostomy, and to thereby improve the situation of clinicians practising in dysphagia and tracheostomy management through the development of guidelines, protocols and position papers. An important implication of this research is that it established the need for a dysphagia training programme for both speech-language therapists and nurses in critical care in dysphagia and tracheostomy, and thereby monitoring the efficacy of this programme and measuring/monitoring the outcomes of multidisciplinary teamwork in the assessment and management of dysphagia and tracheostomy in critical care.

As aglomerações de empresas têm despertado o interesse de pesquisadores e formuladores de políticas, dadas as suas particularidades, em comparação com os negócios que não se localizam em aglomerações, pois têm havido desempenhos satisfatórios que são obtidos pelas empresas participantes das aglomerações, e desenvolvimento nas localidades em que os aglomerados se instalam. O desenvolvimento local é contribuinte da melhoria da qualidade de vida das regiões, a partir do impacto que é gerado em várias dimensões, quais sejam: espacial, cultural, política, institucional, social, econômica e ambiental. O Arranjo Produtivo Local (APL) é um tipo de aglomerado empresarial que se constitui em um sistema formador de ações coletivas e resultados promissores para determinada região. Assim, é um agente para o desenvolvimento dessa localidade, dada sua capacidade de impactar as dimensões do desenvolvimento local por meio de ações potencializadoras e/ou inibidoras. A proposta deste estudo foi estudar quais, e como, fatores presentes em três arranjos produtivos locais, situados nas regiões Sudeste e Centro-Oeste do Brasil, contribuem ou inibem o desenvolvimento local das regiões em que estão inseridos, a partir das inter-relações entre as dimensões ambiental, cultural, econômica, espacial, institucional, política e social. Os objetivos específicos foram: i) identificar os atores, as dimensões e os fatores presentes nos arranjos produtivos locais, considerando a possível interferência no desenvolvimento local; ii) alocar os fatores conforme as categorias de análise; iii) entender o conjunto dos fatores, das relações e das interações, presentes entre os atores/agentes e as dimensões do desenvolvimento local; iv) compreender os fatores que contribuem para o desenvolvimento local; v) compreender os fatores que inibem o desenvolvimento local. A pesquisa foi de natureza aplicada, abordagem qualitativa e descritiva. A estratégia utilizada para alcançar o objetivo proposto foi o estudo multicasos. As técnicas de coleta de dados foram: entrevistas, observação não participante e análise documental. Para interpretação dos dados foi utilizada a análise de conteúdo a partir das categorias, aspectos: ambientais, culturais, econômicos, espaciais, institucionais, políticos e sociais. Os resultados apontaram que houve desenvolvimento local nos três arranjos estudados, porém com diferenças de impacto entre os fatores formadores de cada dimensão, assim como entre a contribuição de cada dimensão ao desenvolvimento local. Vários fatores apresentaram tanto potencializar quanto inibir o desenvolvimento. Verificou-se que o fator Cooperação, Coletividade é chave para as práticas de desenvolvimento, assim como a dimensão institucional, por ser coordenadora e disseminadora potencial de ações para esse fim. A dimensão econômica ainda é a que mais motiva as ações e estratégias dos arranjos, e a dimensão ambiental tem tido menor motivação, o que tem comprometido, e muito, o desenvolvimento das regiões analisadas. É necessário contemplar visão de maior envolvimento e transformação cultural entre os agentes/atores dos locais. Como sugestões práticas, as políticas (públicas e privadas) devem considerar aspectos imprescindíveis ao desenvolvimento local, quais sejam: a formação da autonomia do arranjo; a flexibilidade quanto as fronteiras espaciais para definição de variados problemas e variadas soluções; a perspectiva de longo prazo; a inovação e o profissionalismo, por uma visão ampla, além da dimensão financeira. / The agglomerations of companies attracted the interest of researchers and policymakers, given their particularities, compared to companies not located in agglomerations, because occurred satisfactory performances by the companies participating in the agglomerations, and development in the localities where the agglomerates settle. The local development contributes to the improvement of the quality of life of the regions, by the impact generated in several dimensions, such as: spatial, cultural, political, institutional, social, economic and environmental. The cluster is a type of industrial agglomerated composed of a system of collective actions and promising results for a given region. Thus, it is an agent for the development of this locality, given its capacity to affect the dimensions of local development through actions that contribute to or inhibit in this development. The research was the purpose of studying which, and how, factors present in three clusters, situated in the Southeast and Center-West regions of Brazil, contribute or inhibit the local development of the regions in which they belong, based on the interrelations between the dimensions: environmental, cultural, economic, spatial, institutional, political and social. The specific objectives were: i) identify the actors, dimensions, and factors present in the clusters, considering the possible interference in local development; ii) allocate the factors according to the categories of analysis; iii) understand the set of factors, relationships and interactions, present between the actors/agents and the dimensions of local development; iv) understand the factors that contribute to local development; v) understand the factors that inhibit local development. The research considered a study of an applied nature, qualitative approach and descriptive. The strategy used to reach the proposed goal was the multi-case study. The techniques of data collection were interviews, non-participant observation, and documentary analysis. For the interpretation of the data, was used the content analysis according to the categories, aspects: environmental, cultural, economic, spatial, institutional, political and social. The results showed that there was local development in the three arrangements studied, but with differences of impact between the factors forming each dimension, as well as between the contribution of each dimension to local development. Several factors have both potentialized and inhibited development. The factor Cooperation, Collectivity was indicated as fundamental for the development practices, as well as the institutional dimension, for having a potential coordinator and disseminator of actions for this purpose. The economic dimension is still the one that most motivates the actions and strategies in the arrangements, and the environmental dimension has less motivation, which has greatly committed the development of the analyzed regions. It is necessary to contemplate a vision of greater involvement and cultural transformation among the agents/actors from locals. As practical suggestions, the policies (public and private) should consider aspects essential to local development, such as: the formation of the autonomy of the arrangement; the flexibility of spatial frontier to define varied problems and solutions; the long-term perspective; the innovation and the professionalism, for a broad vision, beyond the financial dimension.

A prestação do serviço de Odontologia dentro do ambiente hospitalar teve início devido aos benefícios observados com o trabalho de equipes multidisciplinares no cuidado com a saúde. De modo geral, os pacientes são atendidos pelos cirurgiõesdentistas dentro dos hospitais terciários porque sua condição de saúde impede a realização dos procedimentos em consultórios ou unidades de saúde, devido, entre outros, à dificuldade de locomoção ou falta de equipe treinada para atender portadores de enfermidades sistêmicas. Estudos que enfocam esse tema têm observado benefícios importantes na condição de saúde do paciente. Dessa forma, o presente trabalho teve como objetivos: Caracterizar o Serviço de Odontologia Hospitalar no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, nos seguintes aspectos: 1) assistencial: relacionar as atividades quanto ao número de atendimentos por tipo, procedência do paciente (internado ou ambulatorial), patologias de base e enfermaria específica; 2) financeiro: identificar a receita SUS dos procedimentos odontológicos realizados e identificar os custos do Serviço de Odontologia Hospitalar, e 3) percepção dos profissionais cirurgiõesdentistas e Chefes das especialidades médicas usuárias dos serviços de odontologia hospitalar, quanto aos serviços prestados, e a satisfação dos usuários pacientes. Foi realizada uma pesquisa exploratória descritiva com dados relativos ao ano de 2016, através de um estudo de caso. Para identificar a percepção dos profissionais e satisfação dos pacientes com os serviços odontológicos prestados pelo Hospital foram aplicados (em 2017) questionários específicos. Os resultados demonstraram prevalência de atendimentos ambulatoriais, sendo que os principais procedimentos realizados foram tratamentos periodontais, cirurgias e laserterapia. Quanto ao aspecto financeiro, observou-se que nem todos os procedimentos são reembolsados pelo SUS e seus custos ultrapassam o valor recebido. A receita media SUS e o custo por atendimentos foram R$ 59,91 e R$ 5,36 respectivamente. O estudo permitiu também concluir que a percepção / satisfação nas três esferas analisadas é positiva em relação do serviço prestado. Espera-se que as informações encontradas forneçam subsídios para a melhoria contínua do serviço existente dentro do hospital, bem como para outros gestores que desejam implantar a Odontologia Hospitalar em outros centros de referência. / The provision of Dentistry service within the hospital environment began due to the benefits observed with multidisciplinary healthcare providers working together. In general, patients are attended by dentists at tertiary referral hospitals because their health condition which prevents the procedures to be performed in the clinic or health units, due, among others, to the difficulty of locomotion or lack of trained personnel to attend patients with systemic diseases. Studies that focus on this theme have observed important benefits in patient\'s health condition. Thus, the present study aimed to characterize the activities and procedures performed by the team of dental surgeons at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP in 2016 under the following aspects: 1) assistential: to relate the activities regarding the number of attendances according to the patient origin (ambulatory or nursery) and base pathology; 2) financial: identify the oral care procedures SUS revenues obtained and the costs incurred providing the service, and 3) stakeholders perception / satisfaction: evaluate the perception / satisfaction regarding the contribution of the service in the three mains spheres that comprise it: the dentists who provides care, the physician who works together with the dentistry staff and the patient. To meet these objectives, the descriptive exploratory research was chosen through case reports. To measure the perception / satisfaction specific questionnaires were applied for each group in 2017. The results demonstrated the prevalence of ambulatory care and the main procedures performed were periodontal treatments, surgeries and laser therapy. As for the financial aspect, it was observed that the service is deficient, since not all procedures are reimbursed by SUS and the costs exceed the amount received. In average, SUS reimbursed R$5,36 per procedure while the calculated costs were R$ 59,91. The study also concluded that the perception / satisfaction in the three spheres analyzed are positive in relation to the service provided. It is expected the results obtained will provide subsidies for the continuous improvement of the existing service within the hospital, as well for other managers who wish to implement Oral Service Medicine in other referral hospitals.

Made available in DSpace on 2016-08-10T10:54:07Z (GMT). No. of bitstreams: 1 Wladimir Jacome de Queiroz.pdf: 1180747 bytes, checksum: 888d9ebe6ee9cf7d0b0df6dc4c2c7244 (MD5) Previous issue date: 2005-04-18 / In the present work we focused the theme of the production of the Brazilian snakebite serum, emphasizing the political-social character and describing the current politics of public health in this field, with the objective of showing the reality that involves environment, health and education. We studied the current environmental variables of the crisis of the Brazilian snakebite serum, happened in 1985, as well as the social problems generated by this process and the invested resources. We tried to observe the several aspects of the process of production of the snakebite serum in Brazil, related to the used technology, to the opportunities and the threats (analysis of SWOT) of the productive process in Brazil and also to the benefits generated for the population. Finally, after the analysis of the statistical data and factualists, we suggested, starting from a vision generalist, multidisciplinary and global of this subject, viable options for the production of the snakebite serum in Brazil, which would involve technology, government, society and administration of resources. / No presente trabalho, focamos o tema da produção do soro antiofídico brasileiro, enfatizando o caráter político-social e descrevendo a atual política de saúde pública neste campo, com o objetivo de mostrar a realidade que envolve meio ambiente, saúde e educação. Estudamos as variáveis ambientais decorrentes da crise do soro antiofídico brasileiro, ocorrida em 1985, assim como os problemas sociais gerados por este processo e os recursos investidos. Procuramos observar os vários aspectos do processo de produção do soro antiofídico no Brasil, relacionados à tecnologia utilizada, às oportunidades e às ameaças (análise de SWOT) do processo produtivo no Brasil e também aos benefícios gerados para a população. Finalmente, depois da análise dos dados estatísticos e factuais, sugerimos, a partir de uma visão generalista, multidisciplinar e global desta questão, opções mais viáveis para a produção do soro antiofídico no Brasil, as quais envolveriam tecnologia, governo, sociedade e administração de recursos.

INTRODUÇÃO: Observado inicialmente em países desenvolvidos, o envelhecimento populacional atualmente é uma realidade presente também em países em desenvolvimento. O diabetes mellitus consiste em uma doença de caráter crônico, envolve acompanhamento e tratamento por toda a vida, e apresenta dificuldades no monitoramento e na garantia de uma boa adesão dos pacientes às orientações das equipes de saúde. OBJETIVO: Estudar as características dos idosos com diagnóstico de diabetes mellitus tipo 2, cadastrados em uma unidade de saúde da família, em relação à assistência à saúde, parâmetros clínicos de monitoramento e estado nutricional, a partir da avaliação dos prontuários clínicos destes pacientes. MÉTODO: O estudo é descritivo, com abordagem quantitativa, com fonte de dados secundários. O grupo de estudo é composto por usuários atendidos em uma unidade de saúde da família de Ribeirão Preto-SP, com diagnóstico confirmado de diabetes mellitus tipo 2, cadastrados no Sistema de Informação da Atenção Básica (SIAB), com idade igual ou superior a 60 anos, apresentando ao menos uma consulta de acompanhamento no último ano. Foram compilados dados referentes aos hábitos de vida, assistência à saúde e estado nutricional no primeiro ano de acompanhamento na unidade e no ano da coleta da dados. As informações referentes aos dois períodos estudados foram comparadas por meio de estatística descritiva. Para a comparação de médias das variáveis foi usado o teste t de Student para dados pareados. RESULTADOS: Foram analisados os prontuários de 60 idosos, com média de 9 anos de acompanhamento no serviço. Os diagnósticos das comorbidades mais frequentes foram hipertensão arterial sistêmica, dislipidemias e obesidade. Entre os parâmetros bioquímicos, houve redução de hemoglobina glicada (HbA1C), glicemia de jejum e lipídios para homens e redução de colesterol total, HDL colesterol e LDL colesterol entre as mulheres. Ocorreu redução na frequência dos registros de orientação alimentar no segundo período, com orientação específica de nutricionista em apenas 15% dos prontuários. A orientação mais frequente relatada referiu-se ao fracionamento das refeições. Além do nutricionista, o farmacêutico e fisioterapeuta foram os profissionais com maior frequência de visitas domiciliares. Os registros de participação em grupos de educação em saúde representaram apenas 5% da amostra. CONCLUSÃO: Os resultados encontrados evidenciam atendimento clínico eficiente no monitoramento e controle do diabetes mellitus, porém reforçam a necessidade de estímulo às práticas de promoção e prevenção da saúde no âmbito da atenção básica, com o objetivo de prevenção de complicações relacionadas ao envelhecimento e ao diabetes mellitus, contribuindo para melhora da qualidade de vida dos usuários do serviço, aumento da resolutividade da atenção básica e redução dos custos para o Sistema Único de Saúde. / INTRODUCTION: Initially observed in developed countries, the aging population is now present in developing countries. The diabetes mellitus consists in a chronic disease that involves monitoring and treatment for a lifetime, with difficulties to monitoring and to assurance a patient compliance to health team recommendations. OBJECTIVE: To study type 2 diabetes mellitus aged characters, registered in a family health unit, in relation to de health care, medical parameter and nutritional assessment, from medical records of them. METHODS: It\'s a descriptive study, with quantitative approach and secondary data source. The study group is compose of patients treated in a family health unit in Ribeirão Preto - SP, with confirmed type 2 diabetes mellitus diagnosis, register in the Primary Care Information System, aged over 60 years, presenting at least one follow-up visit last year. Data were compiled relating to lifestyle, health care and nutritional status in the first and last year of the monitoring unit. Two periods information were compared using descriptive statistics. To compare the means of the variables we used the Student t test for paired data. RESULTS: The elderly medical records were analyzed with average of nine years in follow-up service. The most common comorbidities diagnosis were hypertension, dyslipidemia and obesity. Among the biochemical parameters, glycated hemoglobin (HbA1c), fasting plasma glucose and blood lipids decreased among men and total cholesterol, HDL cholesterol and LDL cholesterol decreased among women. The frequency of dietary guidance recording decreased in the second period, with specific nutritionist guidance in only 15% of the records.! Fractionation meal is the most frequent orientation reported. In addition to the nutritionist, pharmacist and physiotherapist were professionals with higher frequency of home visits. Records of participation in health education groups accounted for only 5% of the sample. CONCLUSION: The results show efficient medical care in monitoring and control of diabetes mellitus, but reinforce the need for stimulus to promotion and prevention health practices in the scope of primary care, in order to prevent complications related to aging and diabetes mellitus, contributing to improved quality of life for service users, increasing resoluteness of primary care and reducing costs for the Unified Health System.