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

O presente estudo tem o objetivo de analisar as notificações dos incidentes relacionados à assistência à saúde em um hospital universitário brasileiro entre os anos de 2015 e 2016.Para tanto, foram coletados dados secundários dos Eventos Adversos (EA) ocorridos no hospital e registrados no sistema VIGIHOSP, e foram descritos eventos de 8 perfis distintos: Procedimentos cirúrgicos, Quedas, Identificação do Paciente, Flebite, Medicamentos utilizados, Perda do Cateter, Lesão na Pele, e Sangue e Hemocomponentes. Os resultados alcançados têm suporte na literatura, tanto em relação à porcentagem de ocorrência de cada notificação, como também no que diz respeito às notificações que se tornam EA. Uma lacuna foi identificada: a literatura científica reforça bastante o problema da subnotificação e as mazelas dela decorrentes; mas, além desse fato, o que este estudo chama atenção é para a efetividade das notificações incompletas. Sugere-se ao hospital pesquisado a promoção das notificações como parte de uma cultura de segurança, buscando mais os resultados do que os culpados. Propõe-se também a utilização dos EA como indicadores de resultado para a gestão hospitalar, atrelados aos objetivos de qualidade e de custo / This study aims to analyze the reports of incidents related to health care in a Brazilian university hospital during the years 2015 and 2016. To do so, secondary data from Adverse Events (AD) occurred at the hospital and were recorded in the VIGIHOSP system, and events of 8 different profiles were described: Surgical Procedures, Falls, Patient Identification, Phlebitis, Medications Used, Catheter Loss, Skin Injury, and Blood and Hemocomponents. The results obtained are supported in the literature, both in relation to the percentage of occurrence of each notification, as well as with regard to notifications that become AD. A gap has been identified: the scientific literature strongly reinforces the problem of underreporting and the ensuing problems; but beyond this fact, what this study calls attention to is the effectiveness of incomplete notifications. For the researched hospital is suggested to promote the notifications as part of a safety culture, seeking more results than the culprits. It is also proposed the use of AD as outcome indicators for the hospital management, linked to quality and cost objectives

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2014-10-03T21:12:43Z No. of bitstreams: 2 Dissertação - Adriana Helena de Matos Abe - 2011.pdf: 852814 bytes, checksum: 8db7f03ca663f93c40dd3a61fd3c27fe (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-10-03T21:37:01Z (GMT) No. of bitstreams: 2 Dissertação - Adriana Helena de Matos Abe - 2011.pdf: 852814 bytes, checksum: 8db7f03ca663f93c40dd3a61fd3c27fe (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-03T21:37:01Z (GMT). No. of bitstreams: 2 Dissertação - Adriana Helena de Matos Abe - 2011.pdf: 852814 bytes, checksum: 8db7f03ca663f93c40dd3a61fd3c27fe (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2011-04-29 / Introduction: Dengue is the most important emerging and reemerging disease in morbidity and mortality today. Among those affected. 2.5% die, and is increasing the number of deaths in children annually. In this group, in particular, early diagnosis is more difficult. Objectives: To identify clinical and laboratory markers for diagnosis and severity of dengue infection cases reported in the period 2001 to 2009 in children under 15 years old living in the city of Goiania, laboratory confirmed, describe sociodemographic data, tourniquet test and admissions performed. Methodology: Database Information System for disease surveillance of the City Health Department to Goiania was used to do a retrospective, descriptive, exploratory quantitative analysis, using the test of statistical significance t-student test, with significance level 5% and the final statistical analysis in SPSS 17.0. Results: In the period 2001 to 2009 were reported in the city of Goiania, 124,794 cases of dengue, of these 113,744 (91%), referring to residents of the capital. Among those under 15 years reported in this period, 22,278 were residents of Goiania. The tourniquet test was performed in 7428 (33.34%) of these children, 1,415 (6.36%) reported not having performed this test. 13,435 (60.30%), had this spot in blank and 1,222 (16.45%) were described as positive. Were documented 1043 hospitalizations of children in this period. Laboratory confirmation occurred in 10,756 cases. As a final classification was found 77% of Classic Dengue, Dengue with 7.4% of complications, 0.4% of Dengue Hemorrhagic Fever and 0.14% deaths, 15% were not classified. Among the laboratory markers found were registered 1,209 cases with IgM positive cases em108 DEN 1, DEN 2 in 14 cases and DEN 3 in 67 cases, Histopathology was cited positive in 4 cases, the hematocrit ranged from 21% to 81%, among the sociodemographic markers the race / ethnicity most marked in this population was white, children over 11 years were most affected, students complete basic education. The more clinical markers reported were fever, headache. myalgia, prostration; among hemorrhagic manifestations: petechiae and epistaxis; as signs of vascular leakage, ascites, pleural and pericardial effusion; warning sign most frequently reported were abdominal pain; the complications of gravity as myocarditis, shock and neurological manifestations have been reported among others. DEN 2 was the responsible for the highest number of severe symptoms. Conclusions: Were identified clinical markers for diagnosis and severity for Dengue in the period studied. The population of children showed severe signs of vascular leakage and neurological impairment. Despite the incompleteness of some data, it did not limit the study, which serves as the basis for a greater knowledge about dengue in children in this region. / Introdução: A dengue é a doença emergente e reemergente mais importante em morbidade e mortalidade na atualidade. Dentre os acometidos 2,5% morrem, e é crescente o número de óbitos em crianças anualmente. Neste grupo, em particular, o diagnóstico precoce é mais difícil. Objetivos: Identificar os marcadores clínicos e laboratoriais de diagnóstico e gravidade da infecção pelo vírus dengue nos casos notificados no período de 2001 a 2009 em menores de 15 anos residentes no município de Goiânia, confirmados laboratorialmente, descrever dados sócio demográficos, prova do laço e internações realizadas. Metodologia: Foi utilizado o Banco de Dados do Sistema de Informação de Agravos de Notificação da Secretaria Municipal de Saúde de Goiânia para um estudo retrospectivo, descritivo, exploratório de análise quantitativa, utilizando o teste de significância estatística t-student, com nível de significância de 5% e análise estatística final no programa spss 17.0. Resultados: No período de 2001 a 2009 foram notificados no município de Goiânia, 124.794 casos de Dengue, destes 113.744 (91%), referentes a moradores da capital. Dentre os menores de 15 anos notificados neste período, 22.278 eram residentes da Goiânia. A prova do laço foi realizada em 7.428 (33,34%) destas crianças, 1.415 (6,36%) informaram não ter realizado este exame. 13.435 (60,30%), tinham este campo em branco e 1.222 (16,45%) foram descritas como positiva. Foram documentadas 1.043 internações de crianças neste período. A confirmação laboratorial ocorreu em 10.756 casos. Como classificação final encontrou-se 77% de Dengue Clássica, 7,4% de Dengue com Complicações, 0,4% de Febre Hemorrágica da Dengue e 0,14% de óbitos, 15% não foram classificados. Dentre os marcadores laboratoriais encontrados foram registrados 1.209 casos com 1001 positiva, DEN 1 em108 casos, DEN 2 em 14 casos e DEN 3 em 67 casos, Histopatologia citada positiva em 4 casos; o hematócdto variou entre 21% a 81%, dentre os marcadores sócio demográficos a raça/etnia mais assinalada nesta população foi a branca, crianças maiores de 11 anos foram mais atingidas e alunos do ensino fundamental completo. Os marcadores clínicos mais reportados foram febre, cefaléia, mialgia, prostração; dentre as manifestações hemorrágicas: petéquias e epistaxe; como sinais de extravasamento vascular, ascite, derrame pleural e pericárdico; sinal de alerta relatado com maior frequência foi dor abdominal; as complicações de gravidade como miocardite, choque e manifestações neurológicas foram reportadas dentre outras. DEN 2 foi responsável pelo maior número de sintomas graves. Conclusões: Foram identificados marcadores clínicos de diagnóstico e gravidade para Dengue no período estudado. A população infantil apresentou sinais graves de extravasamento vascular e comprometimento neurológico. Apesar da incompletude de alguns dados, a mesma não limitou o estudo, que serve como base para um maior conhecimento sobre a Dengue em crianças nesta região.

O presente estudo tem o objetivo de analisar as notificações dos incidentes relacionados à assistência à saúde em um hospital universitário brasileiro entre os anos de 2015 e 2016.Para tanto, foram coletados dados secundários dos Eventos Adversos (EA) ocorridos no hospital e registrados no sistema VIGIHOSP, e foram descritos eventos de 8 perfis distintos: Procedimentos cirúrgicos, Quedas, Identificação do Paciente, Flebite, Medicamentos utilizados, Perda do Cateter, Lesão na Pele, e Sangue e Hemocomponentes. Os resultados alcançados têm suporte na literatura, tanto em relação à porcentagem de ocorrência de cada notificação, como também no que diz respeito às notificações que se tornam EA. Uma lacuna foi identificada: a literatura científica reforça bastante o problema da subnotificação e as mazelas dela decorrentes; mas, além desse fato, o que este estudo chama atenção é para a efetividade das notificações incompletas. Sugere-se ao hospital pesquisado a promoção das notificações como parte de uma cultura de segurança, buscando mais os resultados do que os culpados. Propõe-se também a utilização dos EA como indicadores de resultado para a gestão hospitalar, atrelados aos objetivos de qualidade e de custo / This study aims to analyze the reports of incidents related to health care in a Brazilian university hospital during the years 2015 and 2016. To do so, secondary data from Adverse Events (AD) occurred at the hospital and were recorded in the VIGIHOSP system, and events of 8 different profiles were described: Surgical Procedures, Falls, Patient Identification, Phlebitis, Medications Used, Catheter Loss, Skin Injury, and Blood and Hemocomponents. The results obtained are supported in the literature, both in relation to the percentage of occurrence of each notification, as well as with regard to notifications that become AD. A gap has been identified: the scientific literature strongly reinforces the problem of underreporting and the ensuing problems; but beyond this fact, what this study calls attention to is the effectiveness of incomplete notifications. For the researched hospital is suggested to promote the notifications as part of a safety culture, seeking more results than the culprits. It is also proposed the use of AD as outcome indicators for the hospital management, linked to quality and cost objectives

Thesis (MPHM. (Curriculum Studies)) -- University of Limpopo, 2019 / The quality of mortality data in South Africa has been questioned because of the high percentage of deaths reported to be due to ill-defined causes. We sought to assess the level of knowledge of doctors on the International Classification of Diseases (ICD) rules for medical certification of cause of death and determine the factors influencing that knowledge. Methods A cross-sectional study was conducted across 12 hospitals in Limpopo Province among the five districts stratified by level of care. Doctors completed selfadministered questionnaire, which included the baseline characteristics and questions that tested their theoretical knowledge of the ICD rules of death certification. The outcome, an adequate level of knowledge was set at a score of ≥ 60%. A chi square test was used to determine the factors associated with the outcome. Ethical approval was obtained from Turfloop Research Ethics Committee, University of Limpopo. Results Of the 301 doctors who participated, 50.5% were female, 64% were junior doctors and 13% were specialists. Up to 49% of doctors worked in the two tertiary hospitals. Only 18% of the doctors have ever attended a Continuing Professional Development (CPD) on the topic. The mean overall score on knowledge of medical certification for all the doctors was 59.80% (±11.95) with 53% obtaining at least 60% on the questionnaire. Doctors lacked knowledge on identifying unnatural deaths and discerning the underlying cause of death. Factors associated with the adequate knowledge included years of clinical experience (p=0.01), previous training (p<0.001), awareness of guidelines (p=0.04), comfort level (p=0.01) and rank (p=0.02). Conclusion The study highlighted the need for training of all doctors in the province and identified the knowledge gaps. Interactive capacity-building workshops have been shown to improve knowledge of doctors on medical certification of cause of death in other studies. To improve the quality of mortality data in Limpopo Province, such workshops must be conducted in all hospitals. Key words: death notification, medical certification, cause of death

In the age of Web2.0, various network services became critical. Exchange of messages between entities in the network is so frequent that information explosion is quite common nowadays. Volume of Information passed is growing up rapidly. With the wide development of web applications, people need to learn how to filter the important messages; service providers have urgent need to trace the ever changing role of users. This research studies the detections of the user interaction scenario, based on the result from the test function in the on-line learning platform. The learning platform users are divided into two groups, teachers and students, based on their roles. Usually students sit for an on-line examination at the end of each learning activity. The teachers are in charge of helping students with their presentations, encouraging those with good grades, and helping the weaker ones to reach their potential. But in the one-to-many teaching method, a teacher needs to face many students and the resultant grade of an examination becomes a heap of fuzzy and difficult to comprehend numbers. Even though some mathematical tools can help the teachers analyze the data, it is still very difficult to provide appropriate response to each student. The purpose of this research motives building an examination system which combines context-awareness and auto-notification, and bring the advantages of digital examination. An inference engine is used to calculate linear regression of learning curve for each student, then review the old data, and transfer the analysis into the learning context. Then the feedback is given to the students under the various learning context or the teacher will get notification after it compile the analysis. Besides analyzing the past data, the linear regression result will be adjusted to fit the characteristics of learning curve and infer the personal goal of the student. If result is better than expected goal, students should be encouraged. On the other hand, the remediable actions will be administered. Those events can be scheduled by the manager of auto-notification system, published in the appropriate time, and achieve the goal of variety, personalization, and automation.

Unsafe injection practices put patients and healthcare providers at risk of infectious disease and have been associated with a wide variety of procedures and settings. Safe Injection Practices are part of Standard Precautions and are aimed at maintaining basic levels of patient safety and provider protections. However, from 1999 - 2009, more than 30 outbreaks of Hepatitis B or Hepatitis C from unsafe injection practices have occurred resulting in more than 150,000 patients being notified of potential exposure. Breaches in injection safety have the potential to be high profile and sensitive, and although individual incidents may vary, the actions that follow are consistent and predictable. Therefore, in collaboration with the Centers for Disease Control and Prevention (CDC), Division of Healthcare Quality Promotion (DHQP), I have compiled resources and templates to assist state and local health departments and individual healthcare facilities in their efforts to effectively communicate with the public and media about these incidents. Once the decision to notify patients has been made, this toolkit will serve as a guide to help the intended users through the notification process. Its purpose will be to help organizations notify patients, establish communication resources to support patient notifications, plan media and communication strategies, and plan the release of notification letters and other media. This toolkit will suggest practical ways to achieve effective communication using a stepwise approach. Resources and example materials are provided in this toolkit to facilitate the implementation of some essential tips and strategies. Once finalized and cleared by the CDC, this toolkit will be available to users through the CDC’s Injection Safety homepage.

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

Thesis (Ph.D.)--Virginia Commonwealth University, 2010. / Prepared for: Dept.of Educational Studies. Title from title-page of electronic thesis. Bibliography: leaves 133-144

Submitted by Lívia Faria Orso (livia_orso@hotmail.com) on 2018-04-19T13:08:51Z No. of bitstreams: 1 dissertação_mestrado_orso_faria_livia.pdf: 2240731 bytes, checksum: 33859f25eb32033ff60f35a5cfe6e9ab (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-04-19T15:03:41Z (GMT) No. of bitstreams: 1 orso_lf_me_bot.pdf: 2240731 bytes, checksum: 33859f25eb32033ff60f35a5cfe6e9ab (MD5) / Made available in DSpace on 2018-04-19T15:03:41Z (GMT). No. of bitstreams: 1 orso_lf_me_bot.pdf: 2240731 bytes, checksum: 33859f25eb32033ff60f35a5cfe6e9ab (MD5) Previous issue date: 2018-03-01 / Introdução: A coqueluche é uma doença que compõe a Lista Nacional de Doenças de Notificação Compulsória, e várias hipóteses têm sido sugeridas para a reemergência da coqueluche no Brasil e no mundo. Sabe-se que a faixa etária mais acometida é constituída por crianças menores de um ano e que o monitoramento rigoroso da segurança vacinal é a principal estratégia para adesão aos programas de imunização. Além disso, é imprescindível que os serviços de vigilância no Brasil se mantenham alertas sobre a situação epidemiológica da coqueluche. Objetivo: Analisar o perfil epidemiológico dos casos de coqueluche em crianças do nascimento há quatro anos de idade, retrospectivos à implantação da vacina dTpa em gestantes, nos municípios de Botucatu e Marília do Estado de São Paulo. Método: Trata-se de um estudo descritivo, comparativo e de série histórica no município de Botucatu e Marília. Os dados foram coletados do Sistema Nacional de Agravos de Notificação (SINAN), de crianças na faixa etária de zero a quatro anos, confirmadas com coqueluche, no período de primeiro de janeiro de 2008 a 31 de outubro de 2014 do município de Botucatu e Marília. Resultados: Observa-se um aumento gradativo dos casos a partir de 2014, nos dois municípios. A sazonalidade dos casos confirmados em Botucatu ocorreu no inverno, com 42,86% de ocorrências, e em Marília, no verão, com 35,71%. A faixa etária mais acometida pela doença foram crianças menores de um ano em ambos os municípios. O exame da distribuição dos casos confirmados por região geográfica mostrou que, em Botucatu, o maior registro de casos foi na zona norte, com 57,14%, e para o município de Marília, na zona sul, com 42,86%. Quanto ao esquema vacinal, Botucatu apresentou vacinação em 57,14% das crianças, e Marília, 52,38%. Em Botucatu, 35,71% das crianças apresentaram complicações da doença, e em Marília, 16,66%, sendo a pneumonia a complicação mais frequente. Em Botucatu e Marília 100% e 92,85% das crianças evoluíram para a cura respectivamente. Conclusão: A vacina pentavalente que contém o componente pertussis, continua sendo uma medida de prevenção importante, porém não está sendo efetiva devido acometimento da faixa etária inferior ao recomendado pela vacina nos dois municípios. Diante disso este estudo sugere estudos que avaliem o perfil epidemiológico da coqueluche após a implementações de medidas de prevenção pelo Ministério da Saúde, como a vacina dTpa na gestante. / Introduction: Pertussis is a disease that belongs to the National List of Compulsory Notification Diseases, and several hypotheses have been suggested for the re-emergence of pertussis in Brazil and worldwide. It is known that the most affected age group is children under one year old and strict monitoring of vaccine safety is the main strategy for adherence to immunization programs. In addition, it is imperative that surveillance services in Brazil be alert about the epidemiological situation of pertussis. Objective: Analyze the epidemiological profile of pertussis cases in children born four years of age, retrospective to the implantation of the dTpa vacine in pregnant women, in the municipalities of Botucatu and Marília, State of São Paulo. Method: This is a descriptive, comparative and historical series study conducted in the cities of Botucatu and Marília. The data were collected from the National System of Notifiable Diseases (SINAN), in children aged 0 to 4 years old, confirmed with pertussis, in the period from January 1, 2008 to October 31, 2014 in the cities of Botucatu and Marília. Results: It is observed a gradual increase in cases from 2014 on in both cities. The seasonality of confirmed cases in Botucatu occurred in winter, with 42.86% occurrences, and in Marília, in the summer, with a percentage of 35.71%. The age group most affected by the disease was formed by children under one year old in both cities. The analysis of the distribution of confirmed cases by geographic region showed that, in Botucatu, the largest case register occurred in the northern area, with 57.14%, and in the city of Marília, it happened in the south area, with 42.86%. Regarding the vaccination scheme, Botucatu presented vaccination in 57.14% of the children, and in Marília the percentage was 52.38%. In Botucatu, 35.71% of the children presented complications of the disease, and in Marília it was 16.66%, with pneumonia being the most frequent complication. In Botucatu and Marília, 100% and 92,85% of the children evolved to cure respectively.Conclusion: The pentavalent vaccine, which contains the pertussis component, still is an important preventive measure, but is not being effective because of the lower age range than the one recommended by the vaccine in the two cities. Therefore, this study suggests studies that evaluate the epidemiological profile of pertussis after the implementation of preventive measures by the Ministry of Health, such as the dTpa vaccine in pregnant women.