Thesis (M.H.S.A.)--University of Michigan, 1976.

Thesis (M.H.S.A.)--University of Michigan, 1976.

A dissertation submitted to the University of Witwatersrand in partial fulfillment of the requirements for the Master of Medicine Speciality Obstetrics and Gynaecology. Johannesburg, 2013 / Wireless communicating networks are becoming more and more utilized. By using Short Message Service (SMS) via mobile phones, patients can be contacted regarding blood results, follow-up appointments and reminders for chronic medication.In this study the use of SMS was put to the test in South Africa, a middle income country. Objectives: 1. To evaluate whether there is better compliance in patients who received a SMS, reminding them of the date of elective surgery, as opposed to patients who did not receive a reminder SMS. 2. To describe demographic and clinical information of women who are booked forelective gynaecological surgery at Chris Hani Baragwanath Academic Hospital Methods: This study was undertaken at Chris Hani Baragwanath Academic Hospital, which offers a gynaecological elective surgery list on every working day.As with any busy hospital, it is not uncommon for women to wait lengthy periods of time for their surgery Participants were recruited and followed-up between 30th May 2011 and 14th of December 2011. Eligible criteria included all women scheduled to undergo surgery with a waiting list of at least one month. Women who did not have mobile phones and women who objected to receiving SMS communications from the researcher on their mobile phones were excluded. Participants less than 18yrs, inability to read English SMS and refusal to participate in the trail were excluded. This was a double-blinded randomized controlled trial, which assessed the impact of a reminder SMS, in addition to the traditional methods of ensuring return for gynaecological surgery on patients remembering to avail themselves for surgery on their specific date. These numbers were randomized by block randomization into intervention group and control group. The Research Randomiser Form v4.0 program was used. Twenty nine patients were randomized to the intervention group who received a reminder SMS and 29 patients to the control group who did not receive the reminder SMS. Only patients with personal cell phones were included in the study. The participants as well as the researcher were blinded and only the supervisor knew who of the participants were randomised in either group. Results: A total of 58 patients were enrolled in this study. Participants included in the study were allocated numbers. The study showed that even though the shortest waiting period was < 2 months and the longest >5 months there was no significant difference in the number of patients that returned for surgery (53% versus 47%). Most of the patients in this study were African, unemployed and agesranged from 17 – 78 years. The primary reasons for their return in order of frequency were the presence of a mass (60%), pain (59%) and bleeding (36%). One of the major findings of this study was that older patients tended not to return for surgery. Surprisingly, patients who waited longer from the time of booking of surgery to the date of surgery, tended to return more frequently. The main reasons for not returning were that patients did not have money for transport and four patients were unreachable and hence lost to follow-up. Conclusion: This study failed to show that reminders by SMS for elective gynaecological surgery are effective. It also demonstrated that older women were more likely not to return for surgery. Perhaps their ability to read or respond to SMS is more limited than younger women. The other significant finding of this study contrary to expectation is that longer waiting periods seemed to encourage a better return rate.

Orientadores: Luis Otávio Zanatta Sarian, Aarão Mendes Pinto Neto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T19:33:49Z (GMT). No. of bitstreams: 1 Santos_AdrianadeCassiaPaivados_D.pdf: 1416577 bytes, checksum: 04f08a157b001398cbbb4d76bd2deaa7 (MD5) Previous issue date: 2013 / Resumo: Introdução: As condições econômicas e sociais encontradas na maior parte da África sub-Saariana são refletidas na qualidade da assistência à saúde. A melhora das condições de assistência ambulatorial e médico-hospitalar, neste contexto, envolve a capacitação do capital humano, isto é, treinamento e formação de profissionais, e alocação de recursos para insumos e infraestrutura. Dadas às limitações econômicas e técnicas do continente, essas ações costumam ser viabilizadas por ações cooperativas entre governos e instituições locais e estrangeiras. No Hospital Central de Maputo (HCM), em cooperação com o Ministério da Saúde de Moçambique (MSM), a Unicamp desenvolveu um projeto de pesquisa visando à identificação de necessidades de infraestrutura hospitalar e capacitação profissional com vistas a melhorar as taxas de infecção hospitalar e a qualidade à assistência em geral. Objetivo: 1) avaliar as ações executadas desde 2008 pelo MSM, junto com outros organismos multinacionais, na Enfermaria de Cirurgia (EC) do HCM, com vistas à humanização e correção de deficiências primárias de infraestrutura e capacitação profissional; e 2) avaliar fatores relacionados às taxas de infecção hospitalar em pacientes internados na EC e elaborar um plano de controle de infecção hospitalar aplicável e exequível segundo as condições locais. Métodos: Na primeira parte do estudo (referente ao objetivo 1), relatamos o processo de melhorias implementadas na EC a partir da aplicação de um Instrumento de Avaliação de Desempenho (IAD), desenvolvido em colaboração com o MSM, cujas funções eram determinar as necessidades de recursos humanos, organização em serviço, segurança do paciente e satisfação da equipe profissional. O IAD também determinava 83 metas, relacionadas aqueles aspectos mencionados. Este instrumento foi inicialmente utilizado em 2009, e a partir dos resultados obtidos foram delineadas e implantadas intervenções voltadas à correção das limitações do serviço. A partir de então, o IAD permaneceu em uso contínuo pelos profissionais da EC e os resultados obtidos subsequentemente são relatados e comentados nesta tese. A segunda parte do estudo (referente ao objetivo 2) trata das duas primeiras de três fases de um estudo de intervenção, desenhado para 1) determinar a taxa de infecção hospitalar (IH) e suas características na Enfermaria de Cirurgia; 2) propor um plano de controle de IH (PCIH) baseado nos achados de 1). A fase 3, que visa a implantação do PCIH e a avaliação de seus resultados, será realizada posteriormente. Resultados: Em janeiro de 2009, na primeira aplicação do IAD, 49% das metas preconizadas já eram atingidas pela EC; após ações baseadas nos resultados da primeira aplicação do IAD, em junho e setembro de 2009, 88% e 90% das metas haviam sido atingidas, respectivamente. Foram detectadas melhoras substanciais nas práticas de enfermagem, níveis de satisfação de pacientes e estudantes, higienização do ambiente hospitalar e organização do serviço. Em 2011, teve início a segunda parte do estudo, referente à infecção hospitalar na EC. A taxa de IH foi estabelecida em 16.6% e esteve associada ao maior tempo de internação dos pacientes e à menor utilização de artigos hospitalares críticos (agulhas, sondas, bisturis, entre outros). Foi desenvolvido um plano de controle de infecção hospitalar que aborda a melhoria do treinamento de profissionais médicos e não médicos para os fatores associados à IH. Conclusões: A intervenção baseada na elaboração e aplicação o IAD permitiu a melhoria de indicadores de qualidade e satisfação em uma Enfermaria de Cirurgia de um hospital moçambicano, e a taxa de infecção na Enfermaria de Cirurgia do HCM pode ser reduzida com intervenções voltadas a redução do tempo de hospitalização e maior investimento em artigos hospitalares críticos / Abstract: Introduction: The economic and social conditions found in most of sub- Saharan Africa are reflected in the quality of health care. The improvement of the conditions of outpatient care and healthcare in this context involves the training of human capital, ie, education and training of professionals, and resource allocation to inputs and infrastructure. Given the economic and technical limitations of the continent, these actions are often made possible by cooperative actions between governments, local and foreign intuitions. In Maputo Central Hospital (HCM), in cooperation with the Ministry of Health of Mozambique (MSM), Unicamp developed a research project aimed at identifying basic needs of hospital infrastructure and professional training in order to decrease hospital infection rates and quality of care in general. Objective: 1) to evaluate actions taken since 2008 by the MSM, along with other international organizations in surgery ward (EC) HCM, to improve humanization and correction of deficiencies related to infrastructure and job training, and 2) to evaluate essential aspects related to hospital infection rates in patients hospitalized at EC and develop a plan for hospital infection control applicable and enforceable according to local conditions. Methods: In the first part of the study (for the purpose of 1), we report the improvement process implemented in EC from the application of a Performance Assessment (PA), developed in collaboration with the MSM, whose duties were to determine the needs of human resources, service organization, patient safety and satisfaction of professional staff. The PA also determined 83 goals, related to those aspects. This instrument was first used in 2009, and from the results obtained was outlined and implemented interventions that aimed at correcting the limitations of the service. Since then, the PA remained in continuous use by professional EC and results are reported and discussed in this thesis. The second part of the study (related to objective 2) addresses the first two of three phases of an intervention study designed to 1) investigate the rate of nosocomial infection (NI) and their characteristics in MS, 2) propose a control plan IH (HICP) based on the findings of 1) Phase 3, which aims to set the HICP and the evaluation of its results, will be held later. Results: In January 2009, the first application of the IAD, 49% of the recommended goals were already stricken ECII; following actions based on the results of the first application of the IAD in June and September 2009, 88% and 90% of the targets had been reached, respectively. We detected substantial improvements in nursing practice, levels of satisfaction of patients and students, hygienic cleaning and service organization. In 2011 began the second part of the study, referring to nosocomial infection in EC. The rate of NI was established in 16.6% and was associated with longer hospital patients staying and less use of hospital critical items (needles, probes, scalpels, etc.). A plan was developed for hospital infection control that addresses the improvement of the training of medical professionals and decrease of nonmedical factors associated with IH. Conclusions: The intervention based on development and implementation PA allowed the improvement of quality indicators and satisfaction in a general ward of a hospital Mozambique, and the rate of infection in the General Infirmary HCM, can be reduced with interventions aimed at reducing the time hospitalization and greater investment in hospital critical articles / Doutorado / Oncologia Ginecológica e Mamária / Doutora em Ciências da Saúde

Made available in DSpace on 2015-07-22T20:50:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-07-28 / O objetivo deste estudo foi apreender, por meio de uma aproximação etnográfica, as representações sociais do stress das(os) enfermeiras(os) que trabalham no Centro de Terapia Intensiva e no Centro Cirúrgico de um hospital público da cidade de João Pessoa (PB). A intenção foi a de entender como as(os) enfermeiras(os) pensam, sentem, elaboram, associam e representam o stress em diferentes contextos de vida profissional e social. Por meio das narrativas e discursos verbais e não verbais dos interlocutores, buscou-se verificar como elas(es) elaboram aquilo que denominam stress, associando-o e definindo-o no seu cotidiano social e cultural. / The aim of this study was to apprehend, by means of an ethnographic approach, the social representations of stress in nurses that work at the Intensive Therapy Unit and Surgical Unit in a public hospital of João Pessoa (PB). We intended to understand how nurses think, feel, elaborate, associate and represent stress in different contexts of their professional and social lives. Through narratives and verbal and non-verbal discourses of the interlocutors, we tried to verify how they elaborate what they call stress, associating and defining it in their social and cultural quotidian. / TEDE / BV UNIFESP: Teses e dissertações