Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-06T19:03:07Z No. of bitstreams: 1 AlaneKarineDantasPereira_DISSERT.pdf: 2375619 bytes, checksum: 7dbf8eab6181ddc925edb9e420ae5d38 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-07T23:58:46Z (GMT) No. of bitstreams: 1 AlaneKarineDantasPereira_DISSERT.pdf: 2375619 bytes, checksum: 7dbf8eab6181ddc925edb9e420ae5d38 (MD5) / Made available in DSpace on 2016-06-07T23:58:46Z (GMT). No. of bitstreams: 1 AlaneKarineDantasPereira_DISSERT.pdf: 2375619 bytes, checksum: 7dbf8eab6181ddc925edb9e420ae5d38 (MD5) Previous issue date: 2013-12-13 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / O trabalho analisa o financiamento da Pol?tica de Sa?de no Estado do Rio Grande do Norte, partindo do pressuposto de que o SUS ? ?bombardeado? pelo ajuste fiscal, enquanto estrat?gia neoliberal de enfrentamento a crise do capital. A trajet?ria do financiamento do SUS exige a compreens?o de dois princ?pios que s?o, essencialmente, contradit?rios: o ?princ?pio da universalidade?, que se caracteriza pela defesa intransigente dos fundamentos da Reforma Sanit?ria, e o ?princ?pio da conten??o dos gastos sociais?, articulado ? pol?tica macroecon?mica que vem sendo desenvolvida no Brasil desde a d?cada de 1990 e que se consubstancia na contemporaneidade. Esse ?ltimo defende a redu??o dos gastos sociais, a manuten??o de super?vit prim?rio e a privatiza??o dos servi?os sociais p?blicos. Considerando essas determina??es, o objetivo dessa pesquisa consistiu em trazer uma reflex?o cr?tica acerca do financiamento da pol?tica de sa?de no Estado do Rio Grande do Norte no per?odo de 2004 a 2012. A partir de uma pesquisa bibliogr?fica e documental, buscou-se analisar o planejamento or?ament?rio, previstos nas Leis de Diretrizes Or?ament?rias (LDO) e nos Planos Plurianuais (PPA), investigando os relat?rios do Tribunal de Contas do Estado do RN e levantando informa??es sobre receitas e despesas com sa?de, disponibilizadas no Sistema de Informa??o Sobre Or?amento P?blico em Sa?de (SIOPS). A an?lise dos dados obtidos, ? luz do referencial te?rico escolhido, revela tend?ncias da configura??o do or?amento p?blico para a sa?de no Estado do Rio Grande do Norte, quais sejam: a ?nfima participa??o da despesa com investimento na ?rea da sa?de, quando comparada a outros gastos, como o montante empregado em di?rias e publicidade; a alta despesa em gastos com pessoal, especialmente pela contrata??o de cooperativas m?dicas; a forte depend?ncia do Estado de receitas de transfer?ncias da Uni?o; a aplica??o de recursos em a??es de outra natureza, consideradas como sa?de, a exemplo das despesas realizadas pela unidade or?ament?ria Central de Abastecimento S/A (CEASA) na fun??o sa?de e subfun??o suporte profil?tico e terap?utico e no programa de farm?cia popular. A partir de 2006, despesas referentes ao Regime Pr?prio da Previd?ncia dos Servidores (RPPS) da ?rea da sa?de tamb?m v?m sendo consideradas como a??es e servi?os p?blicos de sa?de para fins do limite constitucional, al?m de inconsist?ncias nos PPAs com as a??es efetivamente realizadas. / This work analizes the financing of Health Policies on the state of Rio Grande Do Norte, starting at the presumption that SUS is ?Bombarded? by fiscal ajustments, as a neoliberal strategy to face capital crises.The trafectory of the financing of SUS demands the comprehension of two principles which are, in essence, contradictory: the ?principle of universatility?, which is caracterized by the uncompromising defence of the fundaments of the Sanitary Reform, and the ?principle of containment of social costs?, articulating the macroeconomic policy that has being developed in Brazil since the 1990s and which substantiantes itself on the 2000s.This last defends the reduction of the social costs, the maintanance of primary surplus and the privatization of public social services. Considering these determinations, the objective of this research constitues in bringing a critical reflection sorrounding the financing of the Health Policies on the state of Rio Grande do Norte, on the period from 2004 to 2012.Starting from a bibliografic and documentary research, it sought out to analyze the budget planning forseen on the Budget Guideline Law (LDO) and on the Multiannual Plans (PPA), investigating the reports of the Court of Auditors of the State of RN and gathering information about expenses with health, available on the System of Information About Public Budgeting in Health (SIOPS).The Analises of the data obtained, in light of the theoretic referece chosen, reveals trends in the public budget setting for health on the State of Rio Grande do Norte, which are: a tiny share of investment expenditure on health, when compared to other expenses, the amount used in daily fees and advertising; the high expense in personnel expenses, especially for hiring medical cooperatives;the strong dependence of the state on revenue transferences from the Union; the aplication of resources in actions of other nature considered as health, in exemple of the expenditures undertaken by the budgeting unit Supplying Center S/A (CEASA) on the function of health and subfunction of prophylactic and therapeutic and on the Popular Pharmacy program. Since 2006, expenses refering to Regime Security Servers (RPPA) on the area of health also have being considered as public actions and services in health for constitutional limit ends, beyond the inconsistencies on the PPAs with the actions performed efectively.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-06T22:12:33Z No. of bitstreams: 1 FrancileneAmorimXavier_DISSERT.pdf: 1480840 bytes, checksum: 39809f10fe620827a6bec3f1a6e3fcbf (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-09T00:38:10Z (GMT) No. of bitstreams: 1 FrancileneAmorimXavier_DISSERT.pdf: 1480840 bytes, checksum: 39809f10fe620827a6bec3f1a6e3fcbf (MD5) / Made available in DSpace on 2016-06-09T00:38:10Z (GMT). No. of bitstreams: 1 FrancileneAmorimXavier_DISSERT.pdf: 1480840 bytes, checksum: 39809f10fe620827a6bec3f1a6e3fcbf (MD5) Previous issue date: 2015-10-29 / A mortalidade materna e infantil no Brasil tem se constitu?do como um grave problema de sa?de p?blica, principalmente nas regi?es nordeste e norte. No Rio Grande do Norte, os atuais ?ndices de ?bitos de m?es e beb?s t?m preocupado n?o s? as autoridades de sa?de como ?rg?os da justi?a como o Minist?rio P?blico. Em 2011, o Minist?rio P?blico Estadual ? MPE criou um projeto chamado ?Nascer com Dignidade?, voltado para o acompanhamento da aten??o prestada no pr?-natal, parto e puerp?rio nos munic?pios. O objetivo desse estudo foi investigar como se d? a atua??o do MPE na aten??o materno infantil. O m?todo adotado para levantamento dos dados foi o estudo de caso mediante an?lise dos relat?rios das per?cias realizadas em quatro, das oito Unidades Regionais de Sa?de P?blica (URSAP). Foram selecionados 26 munic?pios e os resultados mostram fragilidades especialmente na aten??o pr?-natal, que podem resultar em complica??es no parto e p?s-parto como: equipes de sa?de da fam?lia incompletas (em 05 munic?pios), falta de acesso ou acesso dificultado a exames laboratoriais (em 16 munic?pios) e falta de vincula??o da gestante ao local do parto (em 26 munic?pios). Com base nessa realidade, o MPE tem adotado medidas relevantes como ajuizamento de A??es Civis P?blicas, celebra??o de Termos de Ajustamento de Conduta com os gestores municipais e realizado interven??es em unidades de sa?de e maternidades do Estado. Dessa forma, entende-se que a interven??o do Minist?rio P?blico ? de suma import?ncia para indicar as adequa??es necess?rias ao enfrentamento da mortalidade materna e infantil estadual (que ? em m?dia de 65/100.000 e 16/100.000 respectivamente) e responsabilizar as prefeituras pela qualidade na assist?ncia de sa?de prestada a seus mun?cipes; exigindo que se cumpram os princ?pios da universalidade e integralidade, com vistas a redu??o das iniquidades sociais. / Maternal and infant mortality have become a serious public health problem in Brazil, especially in northeasternand northern regions.In RioGrande do Norte, the high rates ofdeathsofmothersandbabies haveconcerned not onlythehealthauthorities andjusticeagenciessuch as the prosecution service. In 2011, State Public Ministry (MPE) has developed a proposition which was called ?Nascer com Dignidade?, focused on the monitoring ofcare givenin prenatal, childbirth andpost childbirthin the cities. The aim of thisstudy was toinvestigate how the intervention of MPE works in maternal and child care. The method adopted to survey data was the case study by analyzing the skills of the reports which were carried out in four of the eight Public Health Regional Units (URSAP).A total of 26municipalities were chosenand the results showfragilityparticularly inprenatal care which can result in complicationsin childbirthand postpartumlike:incomplete health family teams(in05cities), lack of access orinaccessibility to laboratory tests(16 cities) and lack of the pregnant woman'sattachment to thebirthing place(in26 cities). Based on this reality, MPE has adopted relevant attitudes as filing public civil suits, compliance of Conduct Adjustment Declaration in the municipal management and performing interventions in heath care centers and maternity clinics of the state. Thereforeit is known thatPublic Ministryis of paramount importanceto indicatethe necessaryadjustmentsto addressinfant and maternalmortalityin the state (mean of 65/100,000 and16/100,000respectively) and give the city hall the responsibility for the health care quality provided to their citizens. These factors demand theprinciples ofuniversality and integrality to be performed in order to reduce social inequities.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-06T22:12:33Z No. of bitstreams: 1 IrapuanMedeirosDeLucena_DISSERT.pdf: 971053 bytes, checksum: dc09173a69f1980f9b3b6eb44ca70869 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-09T19:45:18Z (GMT) No. of bitstreams: 1 IrapuanMedeirosDeLucena_DISSERT.pdf: 971053 bytes, checksum: dc09173a69f1980f9b3b6eb44ca70869 (MD5) / Made available in DSpace on 2016-06-09T19:45:18Z (GMT). No. of bitstreams: 1 IrapuanMedeirosDeLucena_DISSERT.pdf: 971053 bytes, checksum: dc09173a69f1980f9b3b6eb44ca70869 (MD5) Previous issue date: 2015-08-18 / O crescimento da popula??o idosa ? um fen?meno mundial e, no Brasil, essa transforma??o est? acontecendo de forma bastante acelerada. Com o envelhecimento populacional atual, essa faixa et?ria emergente necessitar? de mais aten??o e cuidados ? sa?de. Uma das caracter?sticas do envelhecimento da popula??o ? o ac?mulo progressivo de incapacidades, o que a deixa mais vulner?vel a quedas. Este estudo foi desenvolvido com o prop?sito de conhecer o epis?dio quedas no ?mbito de uma popula??o idosa atendida em uma Unidade de Sa?de da Fam?lia. Trata-se de uma pesquisa de natureza transversal, com uma amostra constitu?da de 121 idosos. A pesquisa foi aprovada pelo Comit? de ?tica do HUOL, com parecer n? 816.022. Foi aplicado um question?rio junto aos participantes e os resultados foram analisados estatisticamente, sendo o teste de Qui-Quadrado e o Exato de Fisher utilizados para verificar a associa??o entre vari?veis. Para a an?lise multivariada, usou-se o m?todo da Regress?o Log?stica Binomial. Para ambos os testes, admitiu-se signific?ncia p<0,05 e IC de 95%. Os resultados demonstram que a maioria ? do sexo feminino, (76,9%); a faixa et?ria de pessoa idosa de 88,4% e 11,6% de sobrenvelhecida; com rela??o ao estado civil, 35,3% s?o casados e 29,4% vi?vos; 92,1% com renda familiar entre um e dois sal?rios m?nimos; e 91,8% moram com o c?njuge e/ou filhos. Com rela??o ? frequ?ncia das quedas, constatou-se que 61,2% dos idosos sofreram uma ou mais quedas em 2014. Como fatores associados, ficou evidente que 73,8% foram decorrentes de fatores extr?nsecos, 6,4% de fatores intr?nsecos e 21,4% de ambos os fatores. Como consequ?ncia da queda, constatou-se que 89,2% t?m medo de cair novamente, 37,3% manifestaram ansiedade e em 13,3% o andar foi afetado. No que diz respeito ? exposi??o aos fatores de riscos, os locais de maior preval?ncia foram: rua/avenida (31,0%), cal?ada (19,0%), sala (14,3%) e p?tio/quintal (10,7%). O estudo comprovou a associa??o estat?stica significativa entre o sexo feminino (p=0,001), entulhos/objetos no quintal (p=0,015) e mobili?rios que podem causar acidentes (p=0,005). Evidenciou-se entre os idosos pesquisados, que 72,7% receberam poucas informa??es sobre quedas, sendo um fator de risco para as quedas. Conclu?mos que existe uma elevada frequ?ncia de quedas em idosos pesquisados, constituindo um dado preocupante, visto que esse evento na popula??o idosa ? bastante grave, sendo necess?rio garantir-lhes um ambiente seguro em seu domic?lio e, sobretudo, fora deste. As informa??es prestadas pela equipe da Estrat?gia Sa?de da Fam?lia s?o importantes para evitar estas ocorr?ncias, refor?ando o desenvolvimento de atividades educativas em sa?de junto ? popula??o como forma de preven??o e redu??o da ocorr?ncia de quedas, melhorando, assim, a qualidade de vida dos idosos. / The growth of the elderly population is a global phenomenon and, in Brazil, this transformation is happening in a very rapid rhythm. With the current population aging, this emerging age group will need more health care and attention. One of the characteristics of the population aging is the progressive accumulation of disabilities, which makes it more vulnerable to falls. This study was developed with the purpose of knowing the episode falls in the scope of an elderly population treated at a Family Health Unit. It is a research with cross-sectional nature, and its sample was composed by 121 elderly. The research was approved by the Ethics Committee of HUOL, with Opinion n? 816.022. We applied a questionnaire to the participants, and the results were statistically analyzed by using Chi-square test and Fisher?s exact test to verify the association between variables. In order to perform a multivariate analysis, we used the method of the Binomial Logistic Regression. For both tests, we accepted significance p<0,05 and CI of 95%. The results prove that the majority belongs to the female gender (76,9%); the age group of elderly reaches 88,4% and 11,6% is over-aged; regarding the marital status, 35,3% are married and 29,4% widowed; 92,1% with family income between one and two minimum wages; and 91,8% live with their partners and/or children. Regarding the frequency of falls, we found that 61,2% of the surveyed elderly suffered one or more falls in 2014. As associated factors, it became clear that 73,8% were due to extrinsic factors, 6,4% to intrinsic factors and 21,4% to both factors. As a consequence of the fall, we found that 89,2% have fear of falling again, 37,3% showed anxiety and 13,3% had their ambulation affected. Concerning the exposure to the risk factors, the most prevalent places were: street/avenue (31,0%), pavement (19,0%), living room (14,3%) and courtyard/backyard (10,7%). The study has proven a statistically significant association among female gender (p=0,001), rubble/objects in the backyard (p=0,015) and furniture that may cause accidents (p=0,005). It was evident among the elderly people surveyed, 72.7% receive little information about falls, being a risk factor for falls. We conclude that there is a high frequency of falls in the surveyed elderly, thereby constituting a worrisome data because this event in the elderly population is a serious matter, which raises the need to ensure them a safe environment in their homes and, above all, outside them. The information provided by the Family Health Strategy team are important to avoid these occurrences, which reinforces the need for developing health education activities together with the population as a way to prevent and reduce the occurrence of falls, thereby improving the quality of life of elderly.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-06T22:34:21Z No. of bitstreams: 1 JosairCustodioDeMesquita_DISSERT.pdf: 839966 bytes, checksum: 98a80295ce6fc97958f43c5fd9329871 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-09T20:43:09Z (GMT) No. of bitstreams: 1 JosairCustodioDeMesquita_DISSERT.pdf: 839966 bytes, checksum: 98a80295ce6fc97958f43c5fd9329871 (MD5) / Made available in DSpace on 2016-06-09T20:43:09Z (GMT). No. of bitstreams: 1 JosairCustodioDeMesquita_DISSERT.pdf: 839966 bytes, checksum: 98a80295ce6fc97958f43c5fd9329871 (MD5) Previous issue date: 2015-11-06 / OBJETIVO: Avaliar a percep??o dos estudantes dos cursos de Medicina e Enfermagem da Universidade Federal do Rio Grande do Norte (UFRN), sobre a assist?ncia ao trabalho de parto e ao parto normal, no contexto do atendimento oferecido pela Maternidade Escola Janu?rio Cicco (MEJC), e contribuir para o planejamento de modifica??es curriculares no ensino da obstetr?cia de acordo com os princ?pios da humaniza??o. METODOLOGIA: Foi realizado um estudo de abordagem transversal e de car?ter descritivo quali-quantitativo, com graduandos em Medicina e Enfermagem da UFRN, que estavam cursando ou j? haviam cursado as disciplinas de obstetr?cia, na medicina e sa?de da mulher, na enfermagem. Os dados foram coletados atrav?s de um question?rio com quest?es objetivas e subjetivas, e armazenados em um banco de dados, em planilha do software Excel/Office 2010 com todas as vari?veis. RESULTADOS: Foram entrevistados 169 estudantes, 118 do curso de medicina e 51 do curso de enfermagem, dos quais 46,75% eram do sexo masculino e 53,25% do sexo feminino. O maior n?mero de entrevistados de medicina estava no 11? per?odo (40,67%), e de enfermagem, no 10?, (43,15%). Esses alunos presenciaram 1.073 partos, dos quais 61,8% via vaginal. Os m?dicos obstetras foram os que mais realizaram partos vaginais (40%). Os enfermeiros realizaram apenas (8,13%). A assist?ncia prestada ?s mulheres, durante o processo do trabalho de parto e parto, configurou-se como adequada para 87,58% dos entrevistados e estes vislumbraram condutas humanizadas. Dos estudantes que realizaram partos, 76,27% eram de medicina e 11,76% eram de enfermagem. Todos receberam orienta??o durante essa atividade. Um total de 19,50% estudantes de medicina relatou existir preconceito contra o parto normal, principalmente quanto ao parto humanizado, ao contr?rio de todos os estudantes de enfermagem (100%) que relataram n?o existir este preconceito. A maioria das estudantes (73%) apresentava prefer?ncia pelo parto vaginal, sobretudo as estudantes de enfermagem. Sobre o conhecimento de mitos em rela??o ao parto normal, 60,35% responderam conhecer algum. CONCLUS?O: O estudo se apresenta como de grande relev?ncia, uma vez que os resultados encontrados podem contribuir para modifica??o e atualiza??o curriculares do ensino da obstetr?cia, como tamb?m servir como subs?dio para a an?lise das pr?ticas de humaniza??o que devem ser desenvolvidas nas institui??es de ensino e que s?o preconizadas pelo Minist?rio da Sa?de. / OBJETIVE: To evaluate the perception of Medical and Nursing students of Medicine and Nursing graduation courses at the Federal University of Rio Grande do Norte (UFRN), on obstetrics teaching and labor assistance in the context of the maternal care provided by the Maternity Hospital Janu?rio Cicco (MEJC) and contribute to curricular updating planning of teaching obstetrics, in accordance with the principles of humanization. METHODS: It was conducted a study of cross-cutting approach and qualitative and quantitative descriptive method, with students in medicine and nursing of UFRN, who were attending or had been attended the midwifery disciplines medicine; and women's health in nursing. The data were collected through a questionnaire with objective and subjective questions, and stored in a database, spreadsheet software Excel / Office 2010 with all the variables. RESULTS: We interviewed 169 students, 118 of medical school and 51 from the nursing program, of which 46.75% were male and 53.25% female. The largest number of medical respondents is the 11th period (40.67%), and nursing, on 10, (43.15%). These students witnessed 1,073 births, and (61.8%) vaginal deliveries. The obstetricians were the most performed vaginal deliveries (40%). Nurses performed only (8.13%). The assistance provided to women during the process of labor and delivery, was configured as suitable for 87.58% of respondents and these glimpsed humane conduct. Students who performed deliveries, 76.27% were medical and 11.76% were nursing. All had guidance while doing them. A total of 19.50% medical students reported that there is a prejudice against vaginal delivery, particularly for the humanized birth, unlike all nursing students (100%) who reported that there is this prejudice. Most students (73%) showed preference for vaginal delivery, especially nursing students. On the knowledge of myths in relation to vaginal delivery, 60.35% answered that they know some. CONCLUSION: This study presents itself as a highly relevant, since the results may contribute to curricular changing and updating related to obstetrics teaching, but also serve as a resource for analysis of humanization practices that should be developed in educational institutions and which are recommended by the Ministry of Health.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-15T20:14:30Z No. of bitstreams: 1 PauloSantiagoDeMoraisBrito_DISSERT.pdf: 3516677 bytes, checksum: 2675d96c113aa68c20016e4759709f32 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-20T22:23:27Z (GMT) No. of bitstreams: 1 PauloSantiagoDeMoraisBrito_DISSERT.pdf: 3516677 bytes, checksum: 2675d96c113aa68c20016e4759709f32 (MD5) / Made available in DSpace on 2016-06-20T22:23:27Z (GMT). No. of bitstreams: 1 PauloSantiagoDeMoraisBrito_DISSERT.pdf: 3516677 bytes, checksum: 2675d96c113aa68c20016e4759709f32 (MD5) Previous issue date: 2015-10-28 / A an?lise do l?quor obtido atrav?s de pun??o lombar ? de import?ncia ?mpar na pr?tica m?dica e ganha cada vez mais espa?o no diagn?stico de doen?as autoimunes prim?rias do sistema nervoso e nas dem?ncias. Os estudos mostram que o treinamento em simulador ? capaz de proporcionar aprendizado de habilidades t?cnicas, aquisi??o e reten??o do conhecimento, melhorar a autoconfian?a do aprendiz e possibilita a transfer?ncia para a pr?tica cl?nica. N?s pretendemos com esse estudo avaliar a efetividade do treinamento de estudantes de gradua??o de medicina com manequim simulador para pun??o lombar, levando em considera??o aspectos quantitativos (desempenho em testes padronizados) e qualitativos (percep??o dos estudantes a respeito do m?todo e do processo de ensino-aprendizagem). Foi desenvolvida uma aula pr?tica usando um guia de auto-avalia??o que tamb?m serviu para avalia??o entre pares. Realizamos instru??o atrav?s de v?deo on line indicado para ser assistido antes do treinamento presencial. Os participantes foram divididos em grupos de 5 e tiveram treinamento seguindo os princ?pios da pr?tica deliberada, fornecimento de feedback, e todos os participantes conseguiram executar pelo menos uma pun??o lombar no simulador. Foram aplicados question?rios a respeito de autoconfian?a e qualidade do treinamento. A tem?tica do treinamento em pun??o lombar foi considerada relevante, e a aula pr?tica foi bem avaliada em rela??o ao seu formato. Depois de dois anos do treinamento inicial, parte dos estudantes foi voluntariamente submetida a testes de reten??o do conhecimento. A interven??o pontual mostrou-se capaz de promover reten??o na t?cnica de pun??o lombar, sem equ?vocos significativos, sugerindo a transfer?ncia para uma situa??o real com paciente. / The teaching of the lumbar puncture (LP) technique with simulator is not well systematized in the curricula of medical schools. Studies show that training in the simulator provides learning technical skills, acquisition and retention of knowledge, improve self-confidence of the learner and enables the transfer to clinical practice. We intend this study to introduce simulated training in LP in medical course at the Universidade Federal do Rio Grande do Norte evaluating the experience taking into account quantitative aspects (performance on standardized tests) and qualitative (perception of the students regarding the method and the teaching process learning). The study was conducted in two phases. In the first phase practical training in PL was introduced in the 3rd year of medical school. Seventy-seven students were trained in small groups, guided by a checklist developed in the model Objective Structured Assessment of Technical Skill (OSATS), at this moment they knew they were not under performance evaluation. They were also asked whether they had prior chances to make an LP in patients. At the end of the first phase the students evaluated training in the following areas: teaching technique, simulator realism, time available per group, number of participants per group and relevance to medical practice. In the second phase, two years later, 18 students trained in first stage performed a new LP on the mannequin simulator, and its performance was evaluated through the same checklist of training in order to verify the technical retention. In addition, they answered a multiple choice test about practical aspects of the LP technique. Each participant received individual feedback on their performance at the end of their participation in the study. In the first phase of the study we found that only 4% of students had performed a lumbar puncture in patients until the 3rd year. The training of LP technique with simulator mannequin was considered relevant and the teaching methods was thoroughly evaluated. In the second phase, all participants were successful in implementing the lumbar puncture on the mannequin simulator, compliance with the most steps in a reasonable time, suggesting that would be able to perform the procedure in a patient.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-23T21:17:23Z No. of bitstreams: 1 GleyceAnyFreireDeLima_DISSERT.pdf: 3848100 bytes, checksum: e6fd45cc0f1729541865b18bcb3b8832 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-28T19:28:57Z (GMT) No. of bitstreams: 1 GleyceAnyFreireDeLima_DISSERT.pdf: 3848100 bytes, checksum: e6fd45cc0f1729541865b18bcb3b8832 (MD5) / Made available in DSpace on 2016-06-28T19:28:57Z (GMT). No. of bitstreams: 1 GleyceAnyFreireDeLima_DISSERT.pdf: 3848100 bytes, checksum: e6fd45cc0f1729541865b18bcb3b8832 (MD5) Previous issue date: 2015-12-08 / Este estudo tem o objetivo de compreender o significado dos cuidados paliativos a pessoa idosa para profissionais de sa?de que atuam na aten??o prim?ria. Estudo descritivo e de abordagem qualitativa, com base no processo de codifica??o e compara??o constante da Teoria Fundamentada nos Dados (TFD). Realizado em um N?cleo de apoio ? Sa?de da Fam?lia, e mais tr?s Unidades de Sa?de da Fam?lia do bairro de Felipe Camar?o, Distrito sanit?rio oeste, munic?pio de Natal. Dos 25 participantes, 19 s?o profissionais da Estrat?gia Sa?de da Fam?lia, e 6 do N?cleo de Apoio a Sa?de da Fam?lia, sendo 21 homens e 4 mulheres com experi?ncia m?nimade um ano na aten??o prim?ria ? sa?de.O estudo foi aprovado pelo Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte, sob CAAE n?43895815.4.0000.5537. As entrevistas individuais, realizadas entre julho a setembro de 2015. Os resultados coletados foram gravados em MP4 e transcritos para linguagem escrita, e analisados atrav?s do processo de codifica??o aberta, meio no qual, os conceitos foram identificados e posteriormente seguiu-se a codifica??o axial, onde as categorias foram desenvolvidas sistematicamente e relacionadas. Ap?s estes procedimentos, emergiram tr?s categorias: comportamento dos profissionais de sa?de frente ? assist?ncia em cuidados paliativos na Aten??o Prim?ria, valoriza??o da percep??o subjetiva dos profissionais de sa?de no cuidado a pessoa em processo de finitude e o significado desarticulado frente aos cuidados paliativos na aten??o prim?ria vivenciado entre os profissionais de sa?de. Na seq??ncia, as categorias foram interpretadas e analisadas, mediante o referencial te?rico da fenomenologia social de Alfred Schutz. Diante do comportamento dos profissionais, identificaram-se a descoberta e a profundidade das pressuposi??es atrav?s da estrutura??o e do significado em um sentido comum. Em rela??o ? valoriza??o da percep??o subjetiva dos profissionais, percebe-se a quest?o da complexidade das m?ltiplas rela??es atrav?s de diversos aspectos de sua tarefa central: concentrar uma filosofia da realidade do mundo, ou seja, uma fenomenologia da atitude natural; ante o significado da desarticula??o entre os profissionais de sa?de e a gest?o, compreende-se a realidade eminente representada pela individualidade de interesses especiais da experi?ncia. Conclui-se que a interpreta??o do significado da assist?ncia em cuidados paliativos ao idoso na aten??o prim?ria de sa?de, urge inserir um novo olhar diante da atua??o dos profissionais de sa?de e da gest?o, no que se refere ?s intera??es sociais e experi?ncias futuras, voltadas para popula??es mais velhas e em situa??es cr?nicas de sa?de, impingindo a necessidade de uma intera??o maior da equipe de sa?de na aten??o prim?ria, e consequente melhoria da assist?ncia em cuidados paliativos. / This study aims to understand the significance of palliative care for the elder health care professionals working in primary health care. Descriptive study of qualitative approach. Conducted in three health units of the Family and a core of support for Health, the Felipe Camar?o neighborhood, District of Natal Health West, RN. Of the 25 participants, 19 are professionals of the Family Health Strategy and six of the Center for Support to Health, the majority being women, with minimal professional work experience, a year in primary health care. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte, under CAAE no. 43895815.4.0000.5537. There were individual interviews between July and September 2015, with the use of questionnaire containing open and closed questions on the topic of study. Our results were recorded in MP4 and transcribed into written language, and analyzed using the open coding process medium in which the categories were interpreted and identified, followed by axial coding, where categories were developed and systematically related. Three categories emerged: enhancement of elder health professionals in palliative care, behavioral health professionals across care in palliative care in primary care and disjointed Meaning between palliative care and health professionals. The categories were interpreted and analyzed by the theoretical framework of social phenomenology of Alfred Sch?tz. Regarding the valuation of subjective perception of professionals, it is clear the issue of the complexity of multiple relationships through various aspects of his central task: focus a philosophy of the world's reality, namely a phenomenology of natural attitude; Before the professional behavior were identified: the discovery and depth of assumptions through the structure, and meaning in a common sense, and at the meaning of the disconnection between the health professionals-including that reality imminent can be represented by individuality special interest of the experience. It follows that health professionals understand there is a difficulty facing the assistance in palliative care to the elderly in primary care, and this difficulty, characterized by the complexity of social interactions across the joint teamwork. Although, I believe that the articulation between the teams, work and family, is essential for the subsequent improvement of care in palliative care favoring the health context surrounding the Elder.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-23T21:17:23Z No. of bitstreams: 1 RosaneSousaDeAndrade_DISSERT.pdf: 675189 bytes, checksum: a98d773786d7b38423df176ac2ea2c24 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-28T20:24:24Z (GMT) No. of bitstreams: 1 RosaneSousaDeAndrade_DISSERT.pdf: 675189 bytes, checksum: a98d773786d7b38423df176ac2ea2c24 (MD5) / Made available in DSpace on 2016-06-28T20:24:24Z (GMT). No. of bitstreams: 1 RosaneSousaDeAndrade_DISSERT.pdf: 675189 bytes, checksum: a98d773786d7b38423df176ac2ea2c24 (MD5) Previous issue date: 2015-11-23 / Estomia ? uma abertura de origem cir?rgica, quando h? necessidade de desviar, tempor?ria ou permanentemente, o tr?nsito normal da alimenta??o e/ou elimina??es. O paciente com estomia de elimina??o se v? diante de modifica??es em sua fisiologia, surgindo tamb?m ? necessidade de cuidados com a bolsa coletora. Neste estudo, objetivou-se analisar a Qualidade de Vida (QV) de pessoas vivendo com Estomias Intestinais (EI), atendidos no Centro de Reabilita??o Infantil e Adulto do Rio Grande do Norte (CRI/CRA-RN). Trata-se de um estudo anal?tico, com delineamento transversal e abordagem quantitativa, realizado com 89 pessoas que apresentaram EI. O estudo foi aprovado pelo Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte (CEP/UFRN), CAAE: 19866413.3.0000.5537. Realizou-se a coleta de dados no per?odo de janeiro a mar?o de 2015 e se utilizou dois instrumentos: um question?rio geral adaptado abrangendo aspectos sociodemogr?ficos, cl?nicos e de autocuidado e um instrumento espec?fico de avalia??o de QV de pessoas com estoma intitulado como City of Hope Quality of Life - Ostomy Questionnaire (COH-QOL-OQ), validado e adaptado para o portugu?s em 2010, composto de quatro dom?nios, a saber: Bem Estar F?sico (BEF), Bem Estar Psicol?gico (BEP), Bem Estar Social (BES) e Bem Estar Espiritual (BEE). Os dados coletados foram inseridos num banco de dados na planilha do aplicativo Microsoft Excel 2007 e processados em software informatizado para as an?lises descritivas e inferenciais. Os resultados mostraram que 83,1% possu?am colostomia e 16,9% ileostomia. Na caracteriza??o sociodemogr?fica predominaram pessoas do sexo masculino (57,3%), acima de 50 anos (57,3%), de cor parda (46,1%), com presen?a de companheiro/a (57,3%), aposentados/benefici?rios (50,5%), renda mensal acima de um sal?rio m?nimo (68,5%) e que estudaram at? o ensino fundamental (67,4%). Quanto aos aspectos cl?nicos, observou-se que a maior causa que culminou com a confec??o do estoma foi ? neoplasia (59,6%) seguida de trauma (21,3%). A amostra apresentou pessoas com estoma h? mais de 6 meses (79,8%), de car?ter definitivo (57,3%), em uso de equipamento pe?a ?nica dren?vel (68,5%) de base plana (82,0%). Com rela??o ao autocuidado, 93,3% esvaziavam e lavavam a bolsa sozinhos (cuidados relacionados ? higiene), mas apenas 75,3% fixava a nova bolsa na pele, durante a troca (cuidados relacionados ? bolsa). A m?dia dos escores de QV dos pesquisados foi de 296,2 (68,90%) para QV Geral; 74,8 (68,03%) para o BEF; 88,8 (68,38%) para o BEP; 79,7 (66,46%) para o BES e 52,7 (75,41%) para o BEE. Diante dos resultados obtidos, conclui-se que se tratou de uma amostra predominantemente adulta/idosa (entre 50 e 70 anos), com baixa escolaridade e como causa motivadora do estoma, as neoplasias. Entretanto, tais achados n?o repercutiram em baixos ?ndices percentuais acerca da capacidade de realiza??o de autocuidado nem em baixos escores de QV. / Ostomy is an open surgical origin, when it is necessary to deviate temporarily or permanently, the normal transit of food and / or deletions. The patient with ostomy disposal is faced with changes in their physiology, also emerging on the need to care collection bag. This study aimed to analyze the quality of life (QOL) of people living with ostomy Intestinal (EI), who attended the Pediatric and Adult Rehabilitation Center of Rio Grande do Norte (CRI / CRA-RN). It is an analytical study with cross-sectional design and quantitative approach, accomplished with 89 people who had EI. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (CEP / UFRN), CAAE: 19866413.3.0000.5537. Held data collection in the period January-March 2015 using two instruments: an adapted general questionnaire covering socio-demographic, clinical and self-care and a specific instrument for assessing QOL of people with stoma titled as City of Hope Quality of Life - Ostomy Questionnaire (COH-QOL-Q), validated and adapted to Portuguese in 2010, composed of four areas, namely: Welfare Body (BEF), Welfare Psychological (BEP), Welfare (BES ) and Spiritual Well-Being (BEE). The collected data were entered into a database in Microsoft Excel 2007 spreadsheet application and processed in computerized software for descriptive and inferential analysis. The results showed that 83.1% had a colostomy and ileostomy 16.9%. Sociodemographic characteristics prevailed in males (57.3%), over 50 (57.3%), mulatto (46.1%), with presence of companion / a (57.3%), retired / beneficiaries (50.5%), monthly income above the minimum wage (68.5%) and who have studied up to elementary school (67.4%). Regarding clinical aspects, it was observed that the main cause that led to the making of the stoma was the neoplasm (59.6%) followed by trauma (21.3%). The sample showed people with stoma for more than six months (79.8%) of permanently (57.3%), in use sink equipment piece drainable (68.5%) of flat base (82.0%). With respect to self-care, 93.3% emptied and washed the bag alone (care related to hygiene) and 75.3% fixed the new exchange on the skin during the exchange (care related to the stock). Patients with more than six months of ostomy and had no partner (a) had higher averages of self-care related hygiene and purse. The average of respondents QoL scores was 68.90% for General QOL; 68.03% for the BEF; 68.38% for the BEP; 66.46% for BES and 75.41% for BEE. Among the aspects that influenced QOL included: physical strength, pain, suffering and gases (physical domain); appearance, care of the stoma and adaptation to new condition (psychological domain); isolation, interference in personal relationships and social activities (social domain) and going to church or synagogue, spiritual activities and positive change after ostomy (spiritual realm). Based on these results, it is concluded that this was a predominantly adult sample / elderly (between 50 and 70 years), with low education and the cause motivating the stoma, neoplasms. However, such findings did not pass at low percentage levels on the self-care capacity to deliver even at low QOL scores.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-23T21:17:22Z No. of bitstreams: 1 SimoneReginaDeCarvalho_DISSERT.pdf: 2186853 bytes, checksum: 826bb3bb54b140e9bbf4a4bd298cdfcb (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-28T20:46:25Z (GMT) No. of bitstreams: 1 SimoneReginaDeCarvalho_DISSERT.pdf: 2186853 bytes, checksum: 826bb3bb54b140e9bbf4a4bd298cdfcb (MD5) / Made available in DSpace on 2016-06-28T20:46:25Z (GMT). No. of bitstreams: 1 SimoneReginaDeCarvalho_DISSERT.pdf: 2186853 bytes, checksum: 826bb3bb54b140e9bbf4a4bd298cdfcb (MD5) Previous issue date: 2015-11-16 / O estudo tem por objetivo analisar o efeito do topiramato sobre o craving em usu?rios de crack. Trata-se de um ensaio cl?nico aberto tipo crossover envolvendo usu?rios do Centro de Aten??o Psicossocial ?lcool e drogas (CAPSad) do munic?pio de Parnamirim/RN, aprovado pelo CEP CAAE: 38710614.1.0000.5537, respeitada a Resolu??o N? 466/2012/CNS. O estudo resultou em dois artigos cient?ficos, um ensaio te?rico e uma revis?o integrativa. No ensaio te?rico de Hinds, Chaves e Cypress, os contextos enfocam desde a problem?tica do uso individual ?s pol?ticas de enfrentamento deste consumo no Brasil, ressaltando que a situa??o de complexidade do fen?meno requerendo estrat?gias de enfrentamento a partir da aten??o integral ao usu?rio, fam?lia e sociedade. A revis?o integrativa captura, dentre os 902 registros trilingui recuperados, oito estudos apresentaram esquemas terap?uticos com efeitos positivos para o craving da coca?na, a partir do uso de nove drogas diferentes. N?o houveram resultados para o craving do crack. Os resultados da amostra do presente estudo foi composta predominantemente por usu?rios do sexo masculino, adultos e solteiros, totalizando 30 sujeitos que atenderam aos crit?rios de inclus?o: adultos, idade a partir de 18 anos, diagn?stico do Manual Diagn?stico e Estat?stico de Transtornos Mentais (DSM-IV) para coca?na/crack; capacidade cognitiva preservada; assiduidade ao servi?o, participar de, no m?nimo, tr?s consultas nos 12 meses anteriores ? coleta dos dados; e aceitar o acompanhamento ao tratamento proposto. Os dados foram coletados no per?odo de dezembro de 2014 a julho de 2015 e analisados por meio de estat?stica descritiva com o suporte do Statistical Package for Social Science (SPSS), atrav?s dos instrumentos: 1) Alcoohol, Smoking, and Substance Involvement Screening Test (ASSIST), aponta, entre outros resultados, que apenas 14% fizeram uso do crack/coca?na semanalmente durante o tratamento, enquanto 83% passaram a fazer uso diariamente ou semanalmente ap?s o per?odo de washout; 2) Escala de Impulsividade de Barratt, com uma m?dia de 80,23 e 77,47 com e sem o tratamento medicamentoso, respectivamente. Uma an?lise a partir do teste t de Student mostram que n?o h? diferen?a significativa na impulsividade com ou sem o uso do medicamento; e 3) Cocaine Craving Questionnaire-Brief (CCQ-Brief), indicando que o n?mero de usu?rios com n?vel de intensidade do craving ? expressivamente maior sem o tratamento medicamentoso (86%) do que com o tratamento (33%). A an?lise entre o craving e a grau de impulsividade mostram que h? uma baixa correla??o (Pearson) entre essas duas vari?veis com medicamento (0,282986) e sem (0,154614), demonstrando que a impulsividade tem baixainflu?ncia sobre o resultado do tratamento medicamentoso. Conclui-se que o topiramato produz efeito positivo para redu??o do craving em usu?rios de crack e que o seu uso constitui estrat?gia relevante para a efic?cia no tratamento de usu?rios de crack. / The study aims to analyze the effects of topiramato on the craving of crack users. It is an open crossover clinical trial involving users from the Psychosocial Care Center for Alcohol and Drugs (CAPSad) in city of Parnamirim, RN, approved by the CEP CAAE: 38710614.1.0000.5537, respecting the norms of the resolution n. 466/2012/CNS. The study produced preliminary two scientific papers: a theoretical essay and an integrative review, as a way of seeking the state of art. The first paper was based in the theoretical framework of Hinds, Chaves and Cypress, which focuses different contexts, from the issues of individual use to the coping policies in Brazil, highlighting that the situation and the complexity of the phenome requires coping strategies for the full attention to the user, family and society. As a result of the integrative review, among the 902 retrieved records, eight of them presented therapeutic schemes with positive effects for the craving of cocaine. They used nine different drugs. It is important to spot out that there was no result for the craving of crack. The data collection was conducted from December 2014 to July 2015 and has as sample predominantly single males. The sample was composed of 30 subjects who met the inclusion criteria: adults, age from 18 years, diagnosis of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for cocaine/crack; cognitive capacity preserved; attendance to the service, participated at least three visits in the 12 months prior to data collection; and accepted to be monitored in the proposed treatment. Data was analyzed using descriptive statistics from the Statistical Package of Support for Social Sciences (SPSS) on the instruments: 1) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), pointing out, among other results, that only 14% used crack/cocaine weekly during treatment, while 83% used daily or weekly after the washout period; 2) Barratt Impulsiveness Scale, with an average of 80.23 and 77.47 with and without drug treatment, respectively. An analysis from the Student t test show no significant differences in impulsivity with or without the drug; and 3) Cocaine-Craving Questionnaire-Brief (CCK-B), indicating that the number of users with craving intensity level is significantly higher without drug treatment (86%) than with treatment (33%). The analysis between craving and level of impulsivity showed that there is a low correlation (Pearson) between these two variables during treatment and after the washout, demonstrating that impulsivity has low influence on the outcome of drug therapy. As conclusion, it was noted that the topiramate produces positive effect on reducing the craving for crack users and their use is a relevant strategy for efficacy in the treatment of crack users.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-27T17:53:00Z No. of bitstreams: 1 LuisAlcidesDeLucenaMarinho_DISSERT.pdf: 1320162 bytes, checksum: cef9d2a20ccf311289d904d465faabe9 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-29T21:36:17Z (GMT) No. of bitstreams: 1 LuisAlcidesDeLucenaMarinho_DISSERT.pdf: 1320162 bytes, checksum: cef9d2a20ccf311289d904d465faabe9 (MD5) / Made available in DSpace on 2016-06-29T21:36:17Z (GMT). No. of bitstreams: 1 LuisAlcidesDeLucenaMarinho_DISSERT.pdf: 1320162 bytes, checksum: cef9d2a20ccf311289d904d465faabe9 (MD5) Previous issue date: 2015-08-07 / INTRODU??O: A doen?a renal cr?nica (DRC) ? um problema de sa?de mundial, com preval?ncia crescente no seu est?gio terminal, fatos que podem ser justificados pela falha no reconhecimento da doen?a e dos seus fatores de risco. OBJETIVO: Avaliar o perfil de conhecimento de m?dicos residentes (MR) e m?dicos preceptores (MP) em hospitais da Universidade Federal do Rio Grande do Norte em Natal-RN - Brasil, sobre a DRC, com base na diretriz do Kidney Disease Outcomes Quality Initiative (KDOQI). M?TODOS: Estudo de corte transversal, onde 64 MR (R1=32; R2=15; R3=17) e 63 MP responderam um question?rio baseado na diretriz do KDOQI, dividido em sete sess?es, abordando aspectos da DRC desde a defini??o, at? o encaminhamento ao nefrologista. RESULTADOS: Apenas 20 participantes (15.7%) informaram utilizar alguma diretriz para o manejo da DRC. Os scores obtidos por sess?o foram: Defini??o e classifica??o (46.1?47.8); Fatores de risco (70.5?27.9); Avalia??o laboratorial (58.2?8.8); Plano de a??o cl?nica (57.6?19.9); Redu??o da protein?ria (68.3?15.0); Complica??es (64.8?19.9); Encaminhamento ao nefrologista (73.0?44.6). Observamos que houve uma diferen?a estatisticamente significante entre o conhecimento dos MR e MP nas sess?es: Avalia??o laboratorial (MR 61.5?8.4 vs MP 54.8?7.9; p<0.001); Redu??o da protein?ria (MR 73.1?11.4 vs MP 63.5?16.7; p<0.001) e Encaminhamento ao nefrologista (MR 81.2?39.3 vs MP 64.5?48.2; p=0.035). Entre os MR, os R2 obtiveram a melhor pontua??o (R1 63.9?22.6 vs R2 71.9?17.2 vs R3 63.5?22.5; p=0.445). Observamos um baixo percentual de acerto dos m?dicos sobre a defini??o da DRC (MP=46%; R1=40.6%; R2=60%; R3=52.9%; p=0.623), assim como a classifica??o da DRC (MP=34.9%; R1=53.1%; R2=60%; R3=52.9%; p=0.158). CONCLUS?O E CONSIDERA??ES FINAIS: Diretrizes para DRC s?o pouco utilizadas por m?dicos que, mesmo atuando em ambiente universit?rio, ainda exp?em lacunas no conhecimento sobre o tema. Nesse sentido, propomos a realiza??o de uma oficina para os m?dicos participantes e estudantes do internato da UFRN, utilizando estrat?gias educacionais centradas no estudante, no sentido de fortalecer a incorpora??o das diretrizes da DRC no ensino de gradua??o e na pr?tica cl?nica de m?dicos em geral. / INTRODUCTION: Chronic kidney disease (CKD) is a global health problem, with increasing prevalence in its terminal stage and one of the factors that can contribute is the failure to recognize the disease and its risk factors. OBJECTIVE: To evaluate the knowledge of medical residents (MR) and medical preceptors (MP) in hospitals in the Federal University of Rio Grande do Norte in Natal-RN - Brazil, on the DRC, based on the policy of the Kidney Disease Improving Global Outcomes (KDIGO ). METHODS: Cross-sectional study where 64 MR (R1 = 32; R2 = 15; R3 = 17) and 63 MP answered a questionnaire divided into seven sessions that addressed aspects of the DRC since the setting up referral to a nephrologist. RESULTS: Only 20 participants (15.7%) reported using any guidelines for the management of CKD. The scores obtained by session were: Definition and classification (46.1 ? 47.8); Risk factors (70.5 ? 27.9); Laboratory evaluation (58.2 ? 8.8); Clinical action plan (57.6 ? 19.9); Reduction in proteinuria (68.3 ? 15.0); Complications (64.8 ? 19.9); Referral to a nephrologist (73.0 ? 44.6). There was a statistically significant difference between the knowledge of MR and MP in the sessions: Laboratory evaluation (MR 61.5 ? 8.4 vs 54.8 ? 7.9 MP; p <0.001); Reduction in proteinuria (73.1 ? 11.4 vs MR MP 63.5 ? 16.7; p <0.001) and Referral to a nephrologist (MR 81.2 ? 39.3 vs 64.5 ? 48.2 MP; p = 0.035). Among the MR, the R2 obtained the best score (63.9 ? 22.6 vs R1 R2 R3 71.9 ? 17.2 vs 63.5 ? 22.5, p = 0.445). It identified a low percentage of success of the doctors on the definition of CKD (MP = 46%; R1 = 40.6%; R2 = 60%; R3 = 52.9%; p = 0.623) and classification (MP = 34.9%; R1 = 53.1%, R2 = 60%; R3 = 52.9%; p = 0.158). CONCLUSION: The study showed that most doctors do not use any guidelines for clinical management of CKD and that there are gaps in knowledge on the subject, even among physicians who work in the university environment. In this sense, we propose the realization of mini-workshops for participants and students from boarding UFRN, using Case-Based Learning Strategy (CBL), with small group discussion, to strengthen the incorporation of CKD guidelines in undergraduate teaching and in clinical medical practice in general.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-07-06T20:12:52Z No. of bitstreams: 1 TheoDuarteDaCosta_TESE.pdf: 4153788 bytes, checksum: 643d900d0fcc28097a487ca70c79ce87 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-07-07T20:35:41Z (GMT) No. of bitstreams: 1 TheoDuarteDaCosta_TESE.pdf: 4153788 bytes, checksum: 643d900d0fcc28097a487ca70c79ce87 (MD5) / Made available in DSpace on 2016-07-07T20:35:41Z (GMT). No. of bitstreams: 1 TheoDuarteDaCosta_TESE.pdf: 4153788 bytes, checksum: 643d900d0fcc28097a487ca70c79ce87 (MD5) Previous issue date: 2015-10-16 / A evolu??o tecnol?gica combinada ? assist?ncia em sa?de proporciona o aumento nos riscos relacionados ? seguran?a do paciente, que torna as institui??es de sa?de ambientes pass?veis e prov?veis de preju?zos no cuidado ofertado. Os setores de alta complexidade, como as Unidades de Terapia Intensiva, possuem tais caracter?sticas destacadas, pois esses espa?os t?m por objetivo cuidar de pacientes em condi??es cl?nicas graves quando o uso de aparatos tecnol?gicos avan?ados torna-se uma necessidade. Diante disso, o objetivo desse estudo foi avaliar o cuidado de enfermagem na perspectiva da seguran?a do paciente em Unidades de Terapia Intensiva. Trata-se de uma pesquisa avaliativa, quanti-qualitativa, que combina formas diferentes de coleta de dados, a saber: observa??o, aplica??o de instrumento de avalia??o e entrevista semiestruturada com pacientes, familiares e profissionais, avaliando, assim, a tr?ade estrutura-processo-resultado do cuidado em enfermagem nas Unidades de Terapia Intensiva. A coleta de dados ocorreu entre abril e julho de 2014, em Unidades de Terapia Intensiva. Para a parte quantitativa (estrutura e processos) foi utilizado a an?lise estat?stica da medida de concord?ncia interobservador denominada Kappa (K), e para a parte qualitativa (entrevistas) a t?cnica de interpreta??o dos dados deu-se com aux?lio do software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionneires (IRAMUTEQ). Os resultados da an?lise da ?estrutura? e ?processos? demonstrou que a maioria dos achados se encontrava fora dos padr?es de adequa??o, o que aponta condi??es prec?rias nas estruturas e, processos incipientes nos servi?os de sa?de. Os ?resultados? indicam que as Unidades de Terapia Intensiva s?o locais seguros, contudo urgem por mudan?as, principalmente na estrutura f?sica e na disponibilidade de materiais. Portanto, aponta-se que o cuidado de Enfermagem desenvolvido nas unidades de terapia intensiva avaliadas cont?m falhas preocupantes com rela??o ? seguran?a do paciente, o que evidencia um quadro de inseguran?a na assist?ncia ofertada e a necessidade de interven??es urgentes no sentido de corrigir as n?o adequa??es apontadas, proporcionando estruturas apropriadas e implanta??o de protocolos e diretrizes de cuidado, para que se consolide um ambiente propicio a seguran?a do paciente. / Technological advances combined with healthcare assistance bring increased risks related to patient safety, causing health institutions to be environments susceptible to losses in the provided care. Sectors of high complexity, such as Intensive Care Units have such characteristics highlighted due to being spaces designed for the care of patients in serious medical condition, when the use of advanced technological devices becomes a necessity. Thus, the aim of this study was to assess nursing care from the perspective of patient safety in intensive care units. This is an evaluative research, which combines various forms of data collection and analysis in order to conduct a deepened investigation. Data collection occurred in loco, from April to July 2014 in hospitals equipped with adult intensive care unit services. For this, a checklist instrument and semi-structured interviews conducted with patients, families, professionals were used in order to evaluate the structure-process-outcome triad. The instrument for nursing care assessment regarding Patient Safety included 97 questions related to structure and processes. Interviews provided data for outcome analysis. The selection of interviewees/participants was based on the willingness of potential participants. The following methods were used to collect data resulting from the instrument: statistical analysis of inter-rater reliability measure known as kappa (K); observations from judges resulting from the observation process; and added information obtained from the literature on the thematic. Data analysis from the interviews was carried out with IRAMUTEQ software, which used Descending Hierarchical Classification and Similarity analysis to aid in data interpretation. Research steps followed the ethical principles presented by Resolution No. 466 of December 12, 2012, and the results were presented in three manuscripts: 1) Evaluation of patient safety in Intensive Care Units: a focus on structure; 2) Health evaluation processes: a nursing care perspective on patient safety; 3) Patient safety in intensive care units: perception of nurses, family members and patients. The first article, related to the structure, refers to the use of 24 items of the employed instrument, showing that most of the findings were not aligned with the adequacy standards, which indicates poor conditions in structures offered in health services. The second article provides an analysis of the pillar of Processes, with the use of 73 items of the instrument, showing that 50 items did not meet the required standards for safe handling due to the absence of adequate scientific guidance and effective communication in nursing care process. For the third article, results indicate that intensive care units were safe places, yet urges for changes, especially in the physical structure and availability of materials and communication among professionals, patients and families. Therefore, our findings suggest that the nursing care being provided in the evaluated intensive care units contains troubling shortcomings with regards to patient safety, thereby evidencing an insecure setting for the assistance offered, in addition to a need for urgent measures to remedy the identified inadequacies with appropriate structures and implement protocols and care guidelines in order to consolidate an environment more favorable to patient safety.