Introduction: Prostate cancer is the most diagnosed cancer in males in Brazil. As it has a relatively indolent evolution and effective screening, patients with localized disease should be referred to the referral centers to perform treatment with curative intent. This study aimed to determine at what stage of the disease patients with prostate cancer are referred to tertiary care and regional referral public hospital for cancer treatment and how these cases were conducted. Methodology: This study included patients diagnosed with prostate cancer from the year 2000 to 2006. They were referred to the University Hospital of Santa Maria (HUSM). The data were described in prevalence percent, being used the Chi Square and Fisher tests, according to application; logistic regression was used to describe potential risk factors, the prevalence ratio was calculated by a non-parametric generalized regression model, using the Poisson distribution, significant statistical difference was considered when p <0.05. Excel 2007 was used to tabulate the data and the analysis was performed using version 18.0 IBM statistical program SPSS for Windows. Results (Article 1): 240 patients with prostate cancer were referred to HUSM during the years 2000 and 2006, of which 59.6% had localized disease, 25% had metastatic disease, and 15.4% had biochemical recurrence. Considering the 143 patients with localized disease, 34.3% were treated with radical prostatectomy, 33.6% with radiotherapy, 20.2% underwent palliative treatments, and 11.9% were under observation. The causes associated with not performing curative treatment of patients with localized disease were: undetermined in 32.6% of the cases, problems due to delay in hospital care in 30.4% of the cases, locally advanced disease in 21.7% of the cases, high surgical risk in 13.1% of the cases, and other reasons in 2.2% of the cases. Of the patients who were referred with localized disease, 20.2% underwent palliative treatments and 11.9% were under observation; in this situation, approximately, one third of the patients with localized disease did not undergo curative treatment due to delay in the waiting list for surgery and, in one third of the cases, the cause was not defined in the medical charts, showing that medical reports were not adequately filled in. Results (Article 2): In patients with localized prostate cancer treated with radical prostatectomy, biochemical recurrence occurred in 34 of 47 patients (72.3%). In this sample, unlike what is described in the literature, there was no correlation between risk ratings and possible risk factors (age, Gleason score, PSA level at diagnosis, T stage) with biochemical recurrence. Conclusions: In comparison with the Medical Literature, there were a greater number of patients referred to a referral hospital with metastatic disease, a lower proportion of patients undergoing curative treatment and less use of radical prostatectomy as a curative treatment. Regarding patients who were treated with radical prostatectomy, there was a higher prevalence of biochemical recurrence. / Introdução: O câncer de próstata é o mais diagnosticado em homens no Brasil. Como tem evolução relativamente indolente e rastreamento efetivo, os pacientes deveriam ser encaminhados, aos centros de referência, com doença localizada para realização de tratamento com intenção curativa. Este estudo objetivou determinar em que estágio da doença os pacientes com câncer de próstata são encaminhados a um hospital público, de atenção terciária e referência regional para tratamento oncológico e como estes casos foram conduzidos. Metodologia: Foram incluídos pacientes com diagnóstico de câncer de próstata confirmados histologicamente entre os anos 2000 e 2006 e que foram encaminhados ao Hospital Universitário de Santa Maria (HUSM). Os dados foram descritos em prevalência por cento, sendo utilizados os testes de Chi Quadrado e Fisher, conforme aplicabilidade; regressão de logística foi utilizada para descrever possíveis fatores de risco; a razão de prevalências foi calculada por um modelo de regressão generalizado não paramétrico, utilizando-se a distribuição de Poisson; foi considerada diferença estatisticamente significativa quando valor de p <0,05. O Excel 2007 foi usado para tabelar os dados e a análise foi realizada utilizando-se a versão 18.0 do programa estatístico IBM SPSS para Windows. Resultados (artigo 1): Foram encaminhados 240 pacientes com câncer de próstata ao HUSM entre os anos 2000 e 2006, sendo que 59,6% com doença localizada, 25% com doença metastática e 15,4% com recorrência bioquímica. Dos 143 pacientes com doença localizada, 34,3% foram tratados com prostatectomia radical; 33,6%, com radioterapia; 20,2% foram submetidos a tratamentos paliativos, e 11,9% ficaram em observação. As causas associadas a não realização de tratamento curativo em pacientes encaminhados com doença localizada foram em: 32,6% dos casos indeterminada, 30,4% por problemas relacionados ao atraso na assistência hospitalar, 21,7% doença localmente avançada, 13,1% alto risco cirúrgico e 2,2% outros motivos. Dos pacientes que foram encaminhados com doença localizada, 20,2% foram submetidos a tratamentos paliativos e 11,9% ficaram em observação; nesta situação, aproximadamente 1/3 dos pacientes com doença localizada não foram submetidos a tratamento curativo por atraso em lista de espera para cirurgia e em 1/3 dos casos a causa não estava definida nos prontuários, mostrando um preenchimento inadequado destes. Resultados (artigo 2): Nos pacientes com câncer de próstata localizado tratados com prostatectomia radical, a recorrência bioquímica ocorreu em 34 dos 47 pacientes (72,3%). Nessa amostra, ao contrário do que descrito na Literatura, não houve correlação entre classificação de risco e dos possíveis fatores de risco (idade, Escore de Gleason, valor do PSA ao diagnóstico, estadiamento T) com recorrência bioquímica. Conclusões: Comparado com a Literatura Médica, obteve-se um maior número de pacientes encaminhados ao hospital de referência com doença metastática, uma menor proporção de pacientes tratados de forma curativa e uma menor utilização de prostatectomia radical como tratamento curativo. E, em relação aos pacientes que foram tratados com prostatectomia radical, houve uma maior prevalência de recorrência bioquímica.

Carta al editor / Revisión por pares

FEITOSA, Raquel Libório. Estilos de liderança e sua relação com comprometimento e clima organizacional - estudo de caso em um hospital público e de ensino. 2008. 140f. – Dissertação (Mestrado) – Universidade Federal do Ceará, Programa de Pós-Graduação em Psicologia, Fortaleza (CE), 2008. / Submitted by Gustavo Daher (gdaherufc@hotmail.com) on 2017-06-16T17:40:25Z No. of bitstreams: 1 2008_dis_rlfeitosa.pdf: 85777846 bytes, checksum: 744b8f3e907fa24e9fa08a20775a41ab (MD5) / Approved for entry into archive by Márcia Araújo (marcia_m_bezerra@yahoo.com.br) on 2017-06-16T18:03:38Z (GMT) No. of bitstreams: 1 2008_dis_rlfeitosa.pdf: 85777846 bytes, checksum: 744b8f3e907fa24e9fa08a20775a41ab (MD5) / Made available in DSpace on 2017-06-16T18:03:38Z (GMT). No. of bitstreams: 1 2008_dis_rlfeitosa.pdf: 85777846 bytes, checksum: 744b8f3e907fa24e9fa08a20775a41ab (MD5) Previous issue date: 2008 / This study aims to analyze the relationship between leadership and commitment styles and the organizational climate in a public training hospital in the State of Ceará. A turning point that directed the research to this type of hospital was the scope and importance of acts performed by such organizations. They carry on practice-theory teaching to a wide extent and develop social welfare by offering a great deal of health assistance. Other important and equally decisive issues in the research were the following aspects in such organizations: the decision-makers are in the highest ranks and either the infrastructure is precarious or resources are often scarce at work. Work psychodynamics and French psychosociology were the theoretical references employed. The qualitative approach was used in the research on leadership styles. Analysis of data and their respective interrelationship was supported by another comprehensive study previously produced during a quantitative-qualitative research on organizational climate and commitment at the same hospital. / O presente estudo tem por finalidade analisar as relações entre estilos de liderança e comprometimento e clima organizacional no contexto de um hospital público e de ensino do estado do Ceará. Um fator decisivo para direcionar a pesquisa para esse tipo de hospital foi a importância e a dimensão dos atos praticados por essas organizações, que desenvolvem um amplo exercício do ensino teórico-prático e realizam, em caráter de missão social, elevado volume de assistência à saúde. Outros fatores igualmente decisivos na escolha foram os seguintes aspectos das referidas organizações: os sujeitos decisórios se encontram em esferas superiores e as infra-estruturas são marcadas pela precarização ou falta constante de recursos para o trabalho. Os principais referenciais teóricos foram a Psicodinâmica do Trabalho e a Psicossociologia francesa. Na pesquisa sobre estilos de liderança, foi utilizada a abordagem qualitativa. Para a análise dos dados, com suas respectivas correlações, considerou-se importante utilizar vasto material produzido anteriormente, por meio de uma pesquisa quanti-qualitativa sobre clima e comprometimento organizacional, realizada no mesmo hospital.

The observed high turnover of nursing staff in some public hospitals in Luanda was assumed to give rise to staff shortages, resulting in work overload for the remaining nurses and poor service delivery. The aim of this study was to determine the reasons for the high turnover of nurses in public hospitals in the city of Luanda, and to determine the actual turnover over a two-year period. The researcher adopted a quantitative approach with an exploratory and descriptive design, using a questionnaire for data collection from a sample of 100 respondents consisting of the Directors of Nursing, Directors of Human Resources and Heads of Departments (ward/units) in seven public hospitals. The study found that the most common reasons for the resignation of nurses were retirement, ill health, and better remuneration and working conditions elsewhere. Lack of motivation could be ascribed to the perceived low remuneration, insufficient supplies and equipment, being overworked due to staff shortages, unsafe working environment and poor conditions of service. Recommendations were made to tackle these issues. It was however not possible to determine the actual extent of nurses resigning from the public hospitals. / Health Studies / M.A. (Health Studies)

Hospitais são instituições complexas e fundamentais na vida do ser humano. Eles consomem quase a metade das despesas destinadas à saúde no Brasil. Devido à especificidade dessas instituições há a genuína dificuldade em adaptar a atividade médica a controles administrativos. No entanto, é possível encontrar hospitais que utilizam o processo orçamentário como ferramenta de gestão. Esse processo pode ser utilizado para alinhar os objetivos entre os gestores e a organização, para estruturação e alocação de esforços, mensuração de desempenho/performance do gestor, atrelando metas a incentivos. Ao deparar-se com um hospital público em que há a presença dessa ferramenta e que conta com ausência de incentivos financeiros para o alcance de metas orçamentárias, com a complexidade da gestão comum a estas instituições, incerteza da tarefa e do embate entre profissionais da área médica e da administração, há o interesse do entendimento de como é a utilização, pelos gestores clínicos, do processo orçamentário para a tomada de decisão. Portanto, este trabalho aplicou um estudo de caso, utilizando entrevistas semiestruturadas, no Hospital das Clínicas de Ribeirão Preto para esse entendimento. Os resultados demonstram que a interação dos gestores com o orçamento se dá predominantemente via planejamento de materiais e incorporação de novas tecnologias. Os instrumentos de gestão utilizados auxiliam nesse planejamento e acompanhamento das atividades que impactam em consumo de recursos. Também foi demonstrado que há a percepção, pelos gestores, de conflitos entre as lógicas administrativa e médica. / Hospitals are complex institutions and fundamental in human life. They consume almost half of the spending on health in Brazil. Because of the specificity of these institutions there is genuine difficulty in adapting to the medical activity management controls. However, it is possible to find hospitals that use the budget process as a management tool. This process can be used to align the goals of managers and the organization for structuring and allocation of effort, performance measurement manager tying goals to incentives. When faced with a public hospital where there is the presence of this tool and it has no financial incentives for achieving budget targets, the complexity of the joint management of these institutions, job uncertainty and the clash between medical professionals and administration, there is interest in understanding how to use the clinical management of the budgeting process for decision making. This study applied a case study using semi-structured interviews, the University Hospital of Ribeirão Preto to this understanding. The results demonstrate that the interaction of managers with budget occurs predominantly through materials planning and incorporation of new technologies. Management tools used to assist in planning the mapping of activities that impact on resource consumption. It was also shown that there is a perception by managers of conflict between administrative and medical logic.

Magister Psychologiae - MPsych

Thesis (Ph.D.(Nursing Science)) -- University of Limpopo, 2021 / The purpose of this study was to develop and implement a training programme to improve the implementation of the nursing process in public hospitals in the Limpopo Province, South Africa. A mixed-method convergent parallel design was used in this study. Qualitative data were collected from 18 professional nurses using a semi structured one-to-one interview using an interview guide. The quantitative data were collected from 283 professional nurses through a self-administered questionnaire. Qualitative data were analysed using Tesch’s open coding method while quantitative data were analysed using Statistical Package for Social Sciences (SPSS) version 24. The findings were merged using a joint display to determine the extent to which the two data confirm, contradict, or expand. The study was guided by Dickoff, James, and Wiedenbach's Practice Orientated theory and Knowles Adult learning theory. The findings revealed that professional nurses perform their activities following the steps of the nursing process, nurses can implement the nursing process timeously but have problems with some steps of the nursing process. Nurses know the importance of recording but the incomplete recording was found to be a challenge, nurses were not attending in-service training on the nursing process leading to poor implementation of the steps, there were inadequate human and material resources, poor management and administrative support affecting the implementation of the nursing process, nurses do not know about the staff training and development policy and there is no training programme on the nursing process in the hospitals. The study, therefore, recommends that the nursing management support for nurses implementing nursing process; provision of adequate human and material resources; scheduling of continuous in-service training sessions for all categories of nurses; adoption of the short training course developed by the Department of Health in the Limpopo Province for in-servicing professional nurses; nursing process be introduced from the first level of nursing training and be reinforced throughout training; the short course should be included in the curriculum of all undergraduate nurse training, and other researchers to develop a model for effective implementation of the nursing process / University of Limpopo

Masters in Public Administration - MPA / There are often noted gaps and tensions arise between official government policies and what is implemented on the ground. The two theories that consistently argue antagonistically about the policy processes are the rational bureaucratic model also called the "top-down approach" as opposed to the incremental or bottom-up approach. This research was inspired by a bottom-up perspective and involves a detailed investigation of Lipsky's street level bureaucracy (SLB) theory. Over the years since Lipsky's research much international work has be done on the subject of discretion among policy implementers but in the South the focus has been more on top-down ideas such as increasing state capacity and monitoring workers and not on the Lipsky problematic. Hence, this study specifically focuses on studying the extent, intentions and uses of discretion. Intentions are look e at in a threefold manner: good, bad and conflicting, among nurses as SLBs in a public hospital in Cape Town, in view of the t wo conflicting approaches to policy implementation. I found that the discretion practices among nurses do 'more good than harm' as opposed to the view held by the top down approach. The study further revealed that discretion is also often conflicted or ambivalent. Moreover, it is often based on tacit collective understandings and practices among groups of nurses. This is one element that needs to be explored further in future studies in order to contribute to the body of knowledge. Notably, there appears to be a gap in South African literature on this vital subject area. 111

Professional nurses and their patients are directly influenced by insufficient medication, causing a decrease in the quality of care, delays in hospitalisation and it might lead to resistance. In some cases professional nurses have to leave the unit in search of medicine. Amoxicillin-clavulanic acid 1.2 gram for intravenous administration is prescribed to the majority of patients in the medical units in public South African hospitals. Yet there are intermitted insufficient stock levels and challenged inventory systems for amoxicillin-clavulanic acid 1.2 gram in some public hospitals. This fact is positioned against the background of a South African health system that has undergone major changes since the fall of Apartheid in 1994 and amidst major positive changes, is still challenged by overburdened hospital admissions and a quadruple disease burden. The aim of this research was to enhance optimal levels of amoxicillin-clavulanic acid 1.2 gram in medical units in public hospitals to ensure sufficient stock levels and timeous administration. The aim was achieved by identifying and describing the current supply chain of intravenous amoxicillin-clavulanic acid 1.2 gram in two medical units in a district (level 2) public hospital in the North West Province (from here referred only as North West) by identifying inefficiencies in the current supply chain and to formulate recommendations for management to enhance the supply chain of intravenous amoxicillin-clavulanic acid 1.2 gram to medical units in public hospitals. An exploratory case study approach was followed to explain the supply chain of amoxicillin-clavulanic acid 1.2 gram by utilising a qualitative, descriptive, explorative and contextual design. A case study approach was chosen as it examined single units within the context of real life as environment, which in this case were medical units in a level two public hospital, North West. The case selection was motivated and described, followed by case records of policies and standard operational procedures. Field participants included all levels of nurses (professional, enrolled and auxiliary) in medical male and female units on day and night duty, and the head of pharmacy [n=8]. Non-probable, purposive sampling was conducted according to inclusion criteria after all levels of ethical clearance and consent were granted. Three semi-structured individual interviews followed, after which two focus groups were conducted. Thematic analysis of transcriptions was done, followed by an analysis of case records regarding where after all results were integrated. Results indicated complex organisational, unit-specific and behavioural challenges that impact on the supply chain management of amoxicillin-clavulanic acid 1.2 gram and insufficient stock levels are predominantly positioned within retailer and customer aspects of the supply chain. Despite well-formulated standard operational procedures, the realisation thereof lacks, implicating a greater need for managerial control. Recommendations were formulated for management to enhance the supply chain of amoxicillin-clavulanic acid 1.2 gram in medical units in public South African hospitals integrated with good pharmacy practices. The close collaboration, mutual respect and effective communication between health professionals in the multi-professional team are reiterated. / MCur, North-West University, Potchefstroom Campus, 2015

Professional nurses and their patients are directly influenced by insufficient medication, causing a decrease in the quality of care, delays in hospitalisation and it might lead to resistance. In some cases professional nurses have to leave the unit in search of medicine. Amoxicillin-clavulanic acid 1.2 gram for intravenous administration is prescribed to the majority of patients in the medical units in public South African hospitals. Yet there are intermitted insufficient stock levels and challenged inventory systems for amoxicillin-clavulanic acid 1.2 gram in some public hospitals. This fact is positioned against the background of a South African health system that has undergone major changes since the fall of Apartheid in 1994 and amidst major positive changes, is still challenged by overburdened hospital admissions and a quadruple disease burden. The aim of this research was to enhance optimal levels of amoxicillin-clavulanic acid 1.2 gram in medical units in public hospitals to ensure sufficient stock levels and timeous administration. The aim was achieved by identifying and describing the current supply chain of intravenous amoxicillin-clavulanic acid 1.2 gram in two medical units in a district (level 2) public hospital in the North West Province (from here referred only as North West) by identifying inefficiencies in the current supply chain and to formulate recommendations for management to enhance the supply chain of intravenous amoxicillin-clavulanic acid 1.2 gram to medical units in public hospitals. An exploratory case study approach was followed to explain the supply chain of amoxicillin-clavulanic acid 1.2 gram by utilising a qualitative, descriptive, explorative and contextual design. A case study approach was chosen as it examined single units within the context of real life as environment, which in this case were medical units in a level two public hospital, North West. The case selection was motivated and described, followed by case records of policies and standard operational procedures. Field participants included all levels of nurses (professional, enrolled and auxiliary) in medical male and female units on day and night duty, and the head of pharmacy [n=8]. Non-probable, purposive sampling was conducted according to inclusion criteria after all levels of ethical clearance and consent were granted. Three semi-structured individual interviews followed, after which two focus groups were conducted. Thematic analysis of transcriptions was done, followed by an analysis of case records regarding where after all results were integrated. Results indicated complex organisational, unit-specific and behavioural challenges that impact on the supply chain management of amoxicillin-clavulanic acid 1.2 gram and insufficient stock levels are predominantly positioned within retailer and customer aspects of the supply chain. Despite well-formulated standard operational procedures, the realisation thereof lacks, implicating a greater need for managerial control. Recommendations were formulated for management to enhance the supply chain of amoxicillin-clavulanic acid 1.2 gram in medical units in public South African hospitals integrated with good pharmacy practices. The close collaboration, mutual respect and effective communication between health professionals in the multi-professional team are reiterated. / MCur, North-West University, Potchefstroom Campus, 2015