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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
51

Lista de verificação de segurança cirúrgica: evidências para a implementação em serviços de saúde / Surgical safety checklist: evidence for implementation in health services

Tostes, Maria Fernanda do Prado 27 April 2017 (has links)
A segurança do paciente cirúrgico é problemática complexa e desafiadora em âmbito global. A presente pesquisa teve como objetivos (a) analisar as evidências disponíveis na literatura sobre o processo de implementação da lista de verificação de segurança cirúrgica da Organização Mundial da Saúde na prática dos serviços de saúde, e (b) analisar o processo de implementação e o uso diário da lista de verificação de segurança cirúrgica, segundo o relato de enfermeiros que atuavam em unidades de centro cirúrgico de hospitais de duas cidades localizadas no estado do Paraná. A pesquisa foi conduzida em duas fases: revisão integrativa e estudo descritivo. A busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL e LILACS. A amostra da revisão integrativa foi composta de 27 pesquisas agrupadas em três categorias, a saber: processo de implementação: estratégias para introdução da lista de verificação de segurança cirúrgica nos serviços de saúde (n=15); processo de implementação: estratégias para otimização do uso da lista de verificação de segurança cirúrgica nos serviços de saúde (n=9) e facilitadores e barreiras para implementação da lista de verificação de segurança cirúrgica nos serviços de saúde (n=3). A condução da revisão integrativa possibilitou compreender o processo de implementação da lista, as diferentes estratégias utilizadas para sua implantação, aspectos da implementação considerados bem-sucedidos ou pouco exitosos no alcance dos resultados esperados, facilitadores e barreiras deste processo. O estudo descritivo foi realizado em 25 hospitais de duas cidades que compõem a mesorregião do Norte Central Paranaense (Londrina e Maringá). Os participantes foram 91 enfermeiros que atuavam em centro cirúrgico dos hospitais selecionados. Para a coleta de dados elaborou-se dois instrumentos, os quais foram submetidos à validação aparente e de conteúdo. Os resultados evidenciaram que, na maioria dos hospitais investigados, a lista de verificação de segurança cirúrgica foi implementada, sendo que, para a maioria dos participantes, as estratégias adotadas na introdução da lista foram o planejamento prévio conduzido pelos enfermeiros, a adaptação com predominância do uso no formato impresso e programa educacional. Com relação ao uso diário da lista, a maioria dos enfermeiros apontou a utilização inadequada desta prática nos seguintes aspectos: adesão parcial ao uso pela equipe cirúrgica, diferença de adesão entre as etapas de checagem e entre as categorias profissionais e condutas inadequadas da equipe cirúrgica na checagem da lista em sala cirúrgica (equipe incompleta, desatenta e sem participação ativa de seus membros). Para a maioria dos participantes, o uso da lista trouxe benefícios ou tem potencial para produzir efeitos benéficos para o paciente, equipe cirúrgica e serviço de saúde. As evidências geradas trazem subsídios para os enfermeiros e demais profissionais de saúde na elaboração de protocolos relativos ao processo de implementação ou uso diário da lista mais adequados e compatíveis com as especificidades estruturais e organizacionais dos serviços de saúde nacionais, com o propósito de viabilizar a integração desta ferramenta no processo de trabalho, melhorar a adesão da equipe e alcançar os melhores resultados em prol da segurança do paciente / Surgical patient safety is a complex and challenging problem at the global level. This study aimed to analyze (a) the available evidence in the literature on the process of implementation of the surgical safety checklist of the World Health Organization in the practice of health services, and (b) the implementation process and the daily use of the surgical safety checklist, according to the report of nurses working in surgical center units of hospitals of two cities located in the state of Paraná. The research was conducted in two phases: integrative review and descriptive study. The search for primary studies was carried out in PubMed, CINAHL and LILACS databases. The sample of the integrative review consisted of 27 studies grouped into three categories, namely: implementation process: strategies for the introduction of the surgical safety checklist in the health services (n = 15); implementation process: strategies to optimize the use of the surgical safety checklist in health services (n = 9) and facilitators and barriers to the implementation of the surgical safety checklist (n = 3). Conducting the integrative review made it possible to understand the process of implementing the list, the different strategies used for its implementation, aspects of implementation considered successful or not very successful in achieving the expected results, facilitators and barriers of this process. The descriptive study was carried out in 25 hospitals of two cities that make up the mesoregion of Northern Central of Paraná state (Londrina and Maringá). Participants were 91 nurses who worked in the surgical center of the selected hospitals. For the data collection, two instruments were elaborated, which were submitted to the apparent validation and content. The results showed that, in most of the hospitals investigated, the surgical safety checklist was implemented, and, for most of the participants, the strategies adopted in the introduction of the list were the previous planning conducted by the nurses, the adaptation with predominance of the use in the printed format and educational program. Regarding the daily use of the list, most of the nurses pointed out the inadequate use of this practice in the following aspects: surgical team\'s partial adherence to the use of it, difference in adherence between the check-up stages, and between the professional categories and inadequate behavior of the surgical team in checking the list in the surgical room (incomplete, inattentive team, and members not taking part actively). For most participants, using the list has brought benefits or can potentially produce beneficial effects for the patient, surgical team, and health service. The evidence generated provides subsidies for nurses and other health professionals in elaborating protocols related to the implementation process or daily use of the list more adequate and compatible with the structural and organizational specificities of the national health services, in order to make feasible the integration of this tool into the work process, to improve team adherence and to achieve the best results for patient safety
52

Eventos químicos no Regulamento Sanitário Internacional (2005): do estado da saúde local ao global / Chemical events in the International Health Regulations (2005): from local to global health statecraft

Agnes Soares da Silva 12 March 2018 (has links)
A produção e o uso global de produtos químicos é alta e está em ascensão. Provocado pela globalização econômica, o movimento trans-fronteiriço de produtos químicos e seus resíduos tornam a exposição humana a produtos químicos um grande risco para a saúde pública. O Regulamento Sanitário Internacional (RSI-2005) revisado reconhece os riscos impostos pelos produtos químicos à saúde pública ao incorporá-los entre aqueles com potencial para se tornar uma Emergência de Saúde Pública de Importância Internacional (ESPII). A falta de implementação do RSI-2005 em um país pode ameaçar a segurança sanitária global. Objetivos: O objetivo geral desta tese é apresentar uma proposta para superar o problema da baixa implementação das capacidades de saúde pública em produtos químicos no RSI-2005 e usar o regulamento como uma plataforma para fortalecer a governança para a saúde pública em produtos químicos em todos os níveis de complexidade dos sistemas de saúde. Os objetivos específicos são: desvendar os determinantes, forças motrizes, caminhos e processos que poderiam levar a eventos químicos com potencial ESPII; propor um construto teórico que possa orientar a governança para a saúde pública nesta questão; e identificar os mecanismos que poderiam facilitar a implementação das principais capacidades de saúde pública em produtos químicos para mitigar riscos. Métodos: A secção de métodos inclui: uma revisão sobre riscos químicos locais e globais, apresentando seus determinantes; revisão do conceito de bens públicos, aplicando-o a aspectos relacionados à segurança química; revisão de eventos químicos passados que poderiam atender aos critérios de potencial ESPII; revisão dos princípios da atenção primária à saúde, explorando possibilidades e oportunidades de incorporar a capacidade em riscos ambientais no contexto dos sistemas locais de saúde para fortalecer a vigilância, o monitoramento e a análise da saúde ambiental em todos os níveis; e proposição de um kit de ferramentas de apoio à implementação das capacidades básicas do RSI-2005 em produtos químicos. Resultados: Esta tese constrói seu argumento na seguinte sequência: \"Segurança Química é um Bem Público Global para a Saúde\"; \"Lições Aprendidas de Surtos Químicos Mortais\"; \"O Estado da Vigilância em Saúde Pública para Incidentes Químicos: Dez Anos de RSI-2005 na América Latina e no Caribe\"; \"Capacidade de Vigilância em Saúde e Resposta: do Local ao Global\"; e \"Um Guia para a Implementação de Capacidades Básicas de Saúde Pública para Eventos Químicos\". Discussão: Existe relação entre as agendas globais e locais. O RSI-2005 pode ser interpretado como uma oportunidade para rever os princípios e as capacidades essenciais de saúde pública e para revitalizar a forma como os sistemas de saúde são organizados, fortalecendo os mecanismos de governança para a saúde e a produção de bens públicos globais para a saúde. Isto requer o envolvimento do setor saúde com a sociedade em geral e um papel proeminente e proativo de liderança da OMS. Conclusão: Atuação local não resolverá problemas globais, mas ela não pode ser desvinculada da atuação global. A necessidade de revisitar e atualizar os sistemas nacionais de saúde para responder a esse contexto de globalização é clara e urgente e o RSI-2005 fornece uma plataforma que pode ser inteligentemente usada na elaboração desta resposta. Não para proteger o comércio e a economia, mas a saúde do povo. / The global production and use of chemicals is high and on the rise. Triggered by economic globalization, the transboundary movement of chemicals and their waste makes human exposure to chemicals a widespread public health risk. The revised International Health Regulations (IHR-2005) recognized the risks posed by chemicals to public health by incorporating them among those with the potential to become a Public Health Emergency of International Concern (PHEIC). Lack of implementation of the IHR-2005 in one country can threaten global health security. Objectives: The general objective of this thesis is to present a proposal to overcome the problem of low implementation of the public health capacities on chemicals in the IHR-2005 and to use the regulations as a framework to strengthen governance for public health on chemicals at all levels of complexity of the health systems. The specific objectives are: to unveil the determinants, main drivers, pathways and processes that could lead to chemical events with potential PHEIC; to propose a theoretical construct that could guide governance for public health on this matter; and to identify the mechanisms that could facilitate the implementation of the core public health capacities on chemicals to mitigate risks. Methods: The methods section includes: a literature review of local and global chemical risks, presenting their drivers; review of the concept of public goods, applying it to aspects related to chemical safety; review of past chemical events that could meet the criteria of potential PHEIC; review of the principles of primary health care, exploring possibilities and opportunities of incorporating capacity on environmental risks in the context of local health systems to strengthen environmental health surveillance, monitoring and analysis at all levels; and proposition of a toolkit for the implementation of the IHR-2005 core capacities on chemicals. Results: This thesis builds its argument in the following sequence: \"Chemical Safety is a Global Public Good for Health\"; \"Lessons Learned from Deadly Chemical Outbreaks\"; \"Status of Public Health Surveillance for Chemical Incidents: Ten Years of IHR-2005 in Latin America and the Caribbean\"; \"From Local to Global Capacity for Health Surveillance and Response\"; and \"A Guide for the Implementation of Core Public Health Capacities on Chemicals\". Discussion: There are linkages between the global and local agendas. The IHR-2005 can be taken as an opportunity to revisit public health principles and core capacities, and revitalize the way health systems are organized, strengthening mechanisms of governance for health, and the delivery of global public goods for health. This requires the engagement of the health sector with the society in general, and a prominent and proactive leadership role of the WHO. Conclusion: Acting local will not solve global problems, but it can no longer be disentangled from acting global. The need to revisit and update national health systems to respond to this context of globalization is clear and urgent, and the IHR-2005 provides a framework that can be smartly used in the elaboration of this response. Not to protect trade and the economy, but the health of the people.
53

International classification of functioning, disability, and health: ICF-CY World Health Organization

Williams, A. Lynn, Louw, Brenda 01 June 2013 (has links)
No description available.
54

The CIDI-Core Substance Abuse and Dependence Questions: Cross-cultural and Nosological Issues

Cottler, Linda B., Robins, Lee N., Grant, B. F., Blaine, Jack D., Towle, Leland H., Wittchen, Hans-Ulrich, Sartorius, Norman 25 March 2013 (has links) (PDF)
The CIDI is a fully standardised, structured interview for the assessment of psychiatric disorders according to DSM-II-R and proposed ICD-10 criteria. The development of this interview has been the collaborative effort of researchers from 18 sites around the world. In a field trial to test the cross-cultural acceptability and reliability of the questions, there was found to be high acceptance and excellent reliability for the substance use questions, problems with the lengthy alcohol section, and difficulties translating relevant substance use concepts into different languages. There is therefore room for further improvement in the substance-related questions. There proved to be differences between ICD-10 and DSM-III-R regarding substance abuse and dependence disorders.
55

The Role of Gender Equality and Economic Development in Explaining Female Smoking Rates

Shariff, Samina 27 April 2007 (has links)
Globally female smoking rates are considerably lower than male smoking rates. However, there is great concern regarding female smoking due to the potential for future increases and the associated harm to health. To gain a better understanding regarding female smoking, this study examines the role of gender equality and economic development in explaining the variability in female smoking rates and female-to-male smoking differentials by examining data from 193 World Health Organization member states. Data on the dependent variables, female smoking prevalence rates and female-to-male smoking prevalence ratio, were obtained from the Tobacco Atlas. Data on independent variables i.e., measures of gender equality and gross national income per capita, proxy measure for economic development, were obtained from the 2005 Human Development Report, Central Intelligence Agency, and the World Bank. A composite gender equality index was constructed from the individual measures of gender equality. Multiple regression analysis showed composite gender equality index and gross national income per capita to be significant positive predictors of relative and absolute female smoking rates, with income being a stronger predicator. Individual measures of gender equality failed to show significance with either dependent variable. The results attest to the need for disentangling smoking from the notion of advancement in gender equality and economic development.
56

Tarptautinių sveikatos priežiūros taisyklių įgyvendinimas Lietuvos Respublikoje / Implementation of International Health Regulations in Republic of Lithuania

Varžgalis, Manvydas 06 February 2009 (has links)
Šiame darbe yra analizuojamos Tarptautinės sveikatos priežiūros taisyklės, aptariant jų istoriją, pagrindinius principus bei įtaką šiuolaikiniu globalizacijos periodu. Tarptautinės sveikatos taisyklės yra neatsiejama dalis, siekiant išvengti tarptautinio infekcinių ligų plitimo tarptautiniu mastu, netrukdant tarptautinei prekybai bei susisiekimui. Norint išlikti visaverte partnere tarptautinėje erdvėje vystant ekonominę, socialinę padėtį, privalu taisykles įgyvendinti. Lietuva, būdama Pasaulio sveikatos organizacijos, Europos Sąjungos narė, ratifikavo taisykles bei įsipareigojo jas įgyvendinti Lietuvos Respublikos Vyriausybės nutarime iki 2012 metų. Pagrindiniai uždaviniai – suderinti atitinkamus teisės aktus su Taisyklių reikalavimais, užtikrinti tinkamą pasirengimą ir reagavimą į ekstremalias visuomenės sveikatai situacijas, keliančias tarptautinį susirūpinimą, taip pat efektyviai ir laiku koordinuoti tokias situacijas, sustiprinti administracinius gebėjimus, kurių reikia reaguojant į ekstremalias visuomenės sveikatai situacijas, keliančias tarptautinį susirūpinimą. Teisinė bazė yra rengiama pakeičiant/priderinant jau egzistuojančias bei kuriant naujas teisės normas. Lietuvos Respublikos Vyriausybė įsipareigoja teisinę bazę galutinai parengti 2009 metais. / This work is an analysis of the International Health Regulations, discussing their history, basic principles and the impact of globalization in the contemporary period. International Health Regulations are an integral part, to prevent the international spread of infectious diseases internationally, impeding international trade and travel. To remain full–fledged partner in international space development in economic, social situation, the regulations must be implemented. Lithuania as the member of World Health Organization and European Union has ratified the regulations, and undertook implement by the resolution of the Goverment Republic of Lithuania until 2012. The main tasks of harmonizing the legislation with the regulations, are to ensure adequate preparedness and response to emergency public health situations which pose an international concern, as well as an efficient and timely coordination of such situations, to reinforce the administrative capacity needed to respond to emergency public health situations which pose an international concern. The legal framework is being prepared modyfing / adjusting existing and the developing new legal norms. The Government of the Republic of Lithuania commited to finalise legal framework in 2009.
57

A Comparison of Patients’ and Nurses’ Perceptions of Cancer Patients’ Quality of Life: A Mixed Research Approach

Bahrami, Masoud, masoud.bahrami@flinders.edu.au January 2008 (has links)
In attempting to give more years of life to cancer patients, their Quality of Life (QoL) during this time has frequently been compromised. Assessment of patients’ QoL provide nurses with an opportunity to know about the whole range of patients’ needs and desires. These information would be potentially very useful for health care professionals particularly nurses for planning, conducting and evaluating the nursing care of cancer patients. Questionnaire survey research carried out in countries other than Australia identified a varied amount of agreement between cancer patients and nurses about cancer patients’ QoL. However, based on the literature review, no research study has been found in Australia that provides a detailed understanding of how nurses and cancer patients are similar or different in their perceptions of cancer patients’ QoL. A research study, therefore, was conducted to answer the following key questions: (a) what differences and/or similarities are there between patients’ and nurses’ perceptions of cancer patients’ QoL; (b) why do these differences and/or similarities exist? A research study with a mixed approach was undertaken to answer the research questions. In the first phase, a survey by questionnaire was conducted. The main aims were to identify: (a) the level of agreement between cancer patients’ and nurses’ scores on the World Health Organisation’s Quality of Life Brief questionnaire (WHOQoL-BREF); and (b) variables that may influence the level of agreement between them. Each patient and nurse was invited to complete the WHOQoL-BREF questionnaire, which was considered as an appropriate tool for evaluating cancer patients’ QoL. This questionnaire considers QoL across four domains or dimensions: physical, psychological, social relationship and environmental. In the first phase of the study, 166 cancer patients and 95 nurses were recruited from three major hospitals in Adelaide, South Australia. The patients had a range of cancer diagnoses with breast cancer being the most prevalent. Most patients were being treated as inpatients with chemotherapy being their primary treatment. The mean age of nurses was approximately 37 years and their clinical experience with cancer patients averaged approximately eight years. Intraclass Correlation Coefficient (ICC) between patients’ and nurses’ scores ranged from ‘poor’ in the social relationship and psychological domains up to ‘moderate’ in the physical domain indicating that generally nurses were different in their perceptions from those of cancer patients. Another major finding of this phase was that nurses underestimated cancer patients’ QoL in the social relationship and environmental aspects, which consisted of more personal and private issues. Having finished the first phase, the second phase was conducted based on the principles of a classical version or mode of grounded theory. The aim here was to include an interpretive perspective and explore the reasons why nurses may differ in their perceptions about cancer patients’ QoL in comparison to cancer patients. In this phase, three cancer patients and 10 nurses took part in semi-structured interviews. Participants were selected from different inpatient and outpatient oncology services and a palliative setting. Differences in patients’ and nurses’ perceptions about cancer patients’ QoL and their implications for nursing clinical practice were discussed further in the light of six important categories found in the second phase including: QoL meanings, QoL aspects, Cues-based QoL assessment; Purpose-based QoL assessment; Facilitators of QoL assessment; and Barriers to QoL assessment. It emerged that QoL has individualised meanings and nurses generally have difficulties understanding their patients’ personal perspective or definition of QoL. Another interpretive outcome that may explain why nurses differed in their perceptions when compared with cancer patients is that nurses’ assessment of cancer patients’ QoL in oncology wards is mainly made during their interaction with patients when providing care. Such an assessment has a focus on physical cues and may not facilitate nurses developing a more holistic picture of cancer patients’ QoL. Participants in the interpretive phase indicated that time limitations, focus on care tasks, and discontinuity of care, all work against nurses developing a more accurate understanding of cancer patients’ QoL. Conversely, it was found that building a relationship and stronger rapport with patients is the main facilitator in improving nurses’ understanding of cancer patients’ QoL.
58

A framework for information communication that contributes to the improved management of the intrapartum period

M’Rithaa, Doreen.K.M January 2015 (has links)
Dissertation submitted in fulfilment of the requirements for the degree Doctor of Technology: Informatics in the Faculty of Informatics and Design at the Cape Peninsula University of Technology / Background: Daily activities within a health care organization are mediated by information communication processes (ICP), which involve multiple health care professionals. During pregnancy, birth and motherhood a woman may encounter different professionals including midwives, doctors, laboratory personnel and others. Effective management requires critical information to be accurately communicated. If there is a breakdown in this communication patient safety is at risk for various reasons such as; inadequate critical information, misconception of information and uninformed decisions being made. Method: Multi method, multiple case study approach was used to explore and describe the complexities involved in the (ICP), during the management of the intrapartum period. During the study the expected ICP, the actual ICP, the challenges involved and the desired ICP were analysed. 24 In-depth interviews with skilled birth attendants were conducted, observer- as- participant role was utilized during the observation, fild notes, reflective diaries and document review methods were used to gather the data. Thematic analysis and activity analysis were applied to analyse the data. Findings: The findings illuminated that there are expectations of accessibility to care of the woman during pregnancy birth and the intrapartum, especially linked to referral processes. The actual ICP focused on documentation and communication of the information within and between organizations. Communication was marked by inadequate documentation and therefore errors in the information communicated. The desires for communication were illuminated by the need to change the current situation. Further a framework for effective information communication was developed: the FAAS framework for the effective management of the intrapartum period. Conclusion: In conclusion what is expected is not what is actually happening. The skilled birth attendants (SBAs) do not necessarily have the answers for change but the challenges were identified as desires for change. I urge that the framework will provide a basis for the evaluation of the effectiveness involved in the ICP for the effective management of the intrapartum period.
59

Lista de verificação de segurança cirúrgica: evidências para a implementação em serviços de saúde / Surgical safety checklist: evidence for implementation in health services

Maria Fernanda do Prado Tostes 27 April 2017 (has links)
A segurança do paciente cirúrgico é problemática complexa e desafiadora em âmbito global. A presente pesquisa teve como objetivos (a) analisar as evidências disponíveis na literatura sobre o processo de implementação da lista de verificação de segurança cirúrgica da Organização Mundial da Saúde na prática dos serviços de saúde, e (b) analisar o processo de implementação e o uso diário da lista de verificação de segurança cirúrgica, segundo o relato de enfermeiros que atuavam em unidades de centro cirúrgico de hospitais de duas cidades localizadas no estado do Paraná. A pesquisa foi conduzida em duas fases: revisão integrativa e estudo descritivo. A busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL e LILACS. A amostra da revisão integrativa foi composta de 27 pesquisas agrupadas em três categorias, a saber: processo de implementação: estratégias para introdução da lista de verificação de segurança cirúrgica nos serviços de saúde (n=15); processo de implementação: estratégias para otimização do uso da lista de verificação de segurança cirúrgica nos serviços de saúde (n=9) e facilitadores e barreiras para implementação da lista de verificação de segurança cirúrgica nos serviços de saúde (n=3). A condução da revisão integrativa possibilitou compreender o processo de implementação da lista, as diferentes estratégias utilizadas para sua implantação, aspectos da implementação considerados bem-sucedidos ou pouco exitosos no alcance dos resultados esperados, facilitadores e barreiras deste processo. O estudo descritivo foi realizado em 25 hospitais de duas cidades que compõem a mesorregião do Norte Central Paranaense (Londrina e Maringá). Os participantes foram 91 enfermeiros que atuavam em centro cirúrgico dos hospitais selecionados. Para a coleta de dados elaborou-se dois instrumentos, os quais foram submetidos à validação aparente e de conteúdo. Os resultados evidenciaram que, na maioria dos hospitais investigados, a lista de verificação de segurança cirúrgica foi implementada, sendo que, para a maioria dos participantes, as estratégias adotadas na introdução da lista foram o planejamento prévio conduzido pelos enfermeiros, a adaptação com predominância do uso no formato impresso e programa educacional. Com relação ao uso diário da lista, a maioria dos enfermeiros apontou a utilização inadequada desta prática nos seguintes aspectos: adesão parcial ao uso pela equipe cirúrgica, diferença de adesão entre as etapas de checagem e entre as categorias profissionais e condutas inadequadas da equipe cirúrgica na checagem da lista em sala cirúrgica (equipe incompleta, desatenta e sem participação ativa de seus membros). Para a maioria dos participantes, o uso da lista trouxe benefícios ou tem potencial para produzir efeitos benéficos para o paciente, equipe cirúrgica e serviço de saúde. As evidências geradas trazem subsídios para os enfermeiros e demais profissionais de saúde na elaboração de protocolos relativos ao processo de implementação ou uso diário da lista mais adequados e compatíveis com as especificidades estruturais e organizacionais dos serviços de saúde nacionais, com o propósito de viabilizar a integração desta ferramenta no processo de trabalho, melhorar a adesão da equipe e alcançar os melhores resultados em prol da segurança do paciente / Surgical patient safety is a complex and challenging problem at the global level. This study aimed to analyze (a) the available evidence in the literature on the process of implementation of the surgical safety checklist of the World Health Organization in the practice of health services, and (b) the implementation process and the daily use of the surgical safety checklist, according to the report of nurses working in surgical center units of hospitals of two cities located in the state of Paraná. The research was conducted in two phases: integrative review and descriptive study. The search for primary studies was carried out in PubMed, CINAHL and LILACS databases. The sample of the integrative review consisted of 27 studies grouped into three categories, namely: implementation process: strategies for the introduction of the surgical safety checklist in the health services (n = 15); implementation process: strategies to optimize the use of the surgical safety checklist in health services (n = 9) and facilitators and barriers to the implementation of the surgical safety checklist (n = 3). Conducting the integrative review made it possible to understand the process of implementing the list, the different strategies used for its implementation, aspects of implementation considered successful or not very successful in achieving the expected results, facilitators and barriers of this process. The descriptive study was carried out in 25 hospitals of two cities that make up the mesoregion of Northern Central of Paraná state (Londrina and Maringá). Participants were 91 nurses who worked in the surgical center of the selected hospitals. For the data collection, two instruments were elaborated, which were submitted to the apparent validation and content. The results showed that, in most of the hospitals investigated, the surgical safety checklist was implemented, and, for most of the participants, the strategies adopted in the introduction of the list were the previous planning conducted by the nurses, the adaptation with predominance of the use in the printed format and educational program. Regarding the daily use of the list, most of the nurses pointed out the inadequate use of this practice in the following aspects: surgical team\'s partial adherence to the use of it, difference in adherence between the check-up stages, and between the professional categories and inadequate behavior of the surgical team in checking the list in the surgical room (incomplete, inattentive team, and members not taking part actively). For most participants, using the list has brought benefits or can potentially produce beneficial effects for the patient, surgical team, and health service. The evidence generated provides subsidies for nurses and other health professionals in elaborating protocols related to the implementation process or daily use of the list more adequate and compatible with the structural and organizational specificities of the national health services, in order to make feasible the integration of this tool into the work process, to improve team adherence and to achieve the best results for patient safety
60

Aplicabilidade da classificação WHO 2008 para os linfomas de células T não-micose fungóide/síndrome de Sézary com expressão primária cutânea / The applicability of the WHO 2008 classification for non-mycosis fungoides/Sezary syndrome T-cell lymphomas with cutaneous primary expression

Daniel Chang 21 October 2010 (has links)
Nas últimas décadas, verificou-se diferenças nas classificações da World Health Organization (WHO) de 2001 e da European Organization for Research and Treatment of Cancer (EORTC) de 1997 para os linfomas cutâneos primários. Em 2005, representantes dessas classificações se reuniram e em consenso estabeleceram a classificação WHO-EORTC que foi adotada pela última classificação da WHO de 2008. O presente estudo visa a avaliar a aplicabilidade dessa nova classificação em casuística retrospectiva de um único centro de referência no diagnóstico e tratamento de linfomas cutâneos. Assim, todos os casos de linfoma cutâneo de células T, excluindo-se micose fungóide (MF) e síndrome de Sézary (SS), no período de 1986 a 2009, foram analisados em relação aos aspectos clínicos, histopatológicos e imunofenotípicos, incluindo-se a realização de novas reações imunoistoquímicas. Os casos foram, então, classificados de acordo com critérios estabelecidos na classificação WHO de 2008. Houve, assim, 33 casos de linfomas cutâneos de células T não-MF e não-SS, sendo 08 (24,2%) de linfoma cutâneo de grandes células anaplásicas, 05 (15,2%) de papulose linfomatóide, 06 (18,1%) de linfoma extranodal de células NK/T tipo nasal, 05 (15,2%) de neoplasia de células dendríticas plasmocitóides blásticas, 05 (15,2%) de linfoma/leucemia de células T do adulto e 04 (12,1%) de linfoma de células T periféricas, sem outra especificação. Portanto, a classificação WHO de 2008 é aplicável à maioria dos casos de linfoma cutâneo de células T não-MF e não-SS. Entretanto, permanecem casos não classificáveis, alguns dos quais com curso clínico agressivo / Recent years have witnessed differences between the World Health Organization (WHO) 2001 and the European Organization for Research and Treatment of Cancer (EORTC) 1997 classification systems of primary cutaneous lymphomas (PCLs). In 2005, a joint WHO-EORTC classification system for PCLs has been reached and was adopted by last WHO 2008 classification. This study was performed to assess the applicability of this new classification to a single referral center. All cutaneous T-cell lymphoma (CTCL) cases, excluding mycosis fungoides (MF) and Sezary syndrome (SS), who were referred from 1986 to 2009 were included. The clinical features, histological and immunohistochemical stainings were reviewed, and additional stains were performed as needed. The cases were then reclassified according to the WHO 2008 classification. There were 33 cases of non-MF and non-SS CTCL, included 08 (24.2%) CD30+ anaplastic large-cell lymphomas, 05 (15.2%) cases of lymphomatoid papulosis, 06 (18.1%) extranodal NK/T-cell lymphoma nasal type, 05 (15.2%) blastic plasmacytoid dendritic cell neoplasm, 05 (15.2%) adult T-cell lymphoma/leukemia and 04 (12.1%) peripheral T-cell lymphomas, unspecified. The new WHO 2008 classification is applicable to most nonMF and non-SS CTCL cases. However, there is still a substantial subset of T-cell PCLs which cannot be classified beyond the unspecified peripheral T-cell category, some of which may have an aggressive course

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