Akademiska sjukhuset är en stor, samhällsviktig verksamhet som har under de senaste tio åren genomgått flertalet ny- och ombyggnationer. Sjukhusområdet är beläget på Uppsalaåsen och befinns inom en primär skyddszon, vilket innebär en komplex geologi och krav på aktsamhet av grundvattnet som nyttjas för Uppsalas vattenförsörjning. Marken har visats innehålla stora lerkörtlar och drastiska skiftningar av jordarter, vilket har lett till en sättningsproblematik vid sjukhusområdet. Region Uppsala planerar flertalet ny- och ombyggnationer vid Akademiska sjukhuset och på grund av den komplicerade markbilden önskas en utredning av geotekniken och hydrogeologin vid området. Fokuset i detta examensarbete har legat på sättningsbenägenhet och grundvattnets trycknivåer. Fyra delområden av sjukhusområdet har pekats ut av Region Uppsala för eventuella framtida byggprojekt. Dessa områden är vid parkeringshus T3, produktionsköket, NOP-komplexet samt ny cyklotronbyggnad. Genomförandet av detta examensarbete har delats in i tre delar; kartläggning av jordlagerföljd, sättningsberäkningar utifrån CRS-försök, samt utredning av grundvattnets trycknivå. Jordlagerföljd har tolkats i GeoSuite med hjälp av 474 sonderingar genomförda av konsultföretaget Bjerking. Sonderingarnas samtliga jordskikt interpolerades och illustrerades som nivåkurvor med hjälp av Topocad. För att utreda jordlagerföljden vid de utvalda områdena skapades åtta tvärsnitt utifrån en 3D-modell konstruerad i Civil 3D. De jordlager som studerats är fyllnadsmaterial, lera, friktionsjord, berg samt markyta. Sättningskapacitet och dess tidsförlopp har beräknats utifrån två CRS-försök och max-, min- och medelvärden av grundvattnets trycknivå under sjukhusområdet har beräknats utifrån 20 års dagliga data från en av Uppsala Vattens mätbrunnar i Stadsträdgården.   Resultaten bekräftar åsens komplexa geologi av varierande lermäktigheter under sjukhusområdet. Det är sannolikt att flertalet byggnationer kräver djupgrundläggning, exempelvis vid parkeringshuset T3 och produktionskökets norra del. De erhållna resultaten visar även knappa lerlager vid andra delområden, vilket innebär mindre sättningsbenägenhet och kräver troligtvis endast ytgrundläggning. De sättningsberäkningar som utförts indikerar att parkeringshuset T3 kommer sjunka 20 till 70 cm efter 158 till 213 år utan grundläggning, något som liknar den pågående sättningen vid byggnaden. Grundvattnets trycknivå har under de senaste 20 åren haft ett medelvärde på + 2,3 m (RH2000) och kommer sannolikt inte fluktuera framåt på grund av den rådande vattendomen. Detta innebär att byggnationer inom vissa delar av sjukhusområdet, exempelvis vid produktionsköket, kommer behöva tillstånd inför byggnation inom den primära skyddszonen, vilket Akademiska sjukhuset är beläget i. Resultaten ger en god överblick över hydrogeologin vid Akademiska sjukhuset och indikerar hur de utpekade områdena bör projekteras med avseende på grundläggning för hållbart och ekonomiskt bygge. Det krävs dock mer underlag, bland annat fler sonderingar och CRS-försök, för att få en ökad komplexitet av sjukhusområdet i avseende på jordlagerföljd och sättningsbenägenhet. / Uppsala University Hospital is a large institution of vital societal function and many new buildings have been constructed and others rebuild during the past ten years. The hospital area is located on Uppsalaåsen and within a primary protection zone, i.e. there is a complex geology and requirements for the protection of the groundwater used for Uppsala’s water supply. The ground contains large sections of clay and has drastic changes in soil types. This has resulted in a subsidence problem within the hospital area. Region Uppsala has several plans regarding upcoming constructions at Uppsala University Hospital and due to the complicated soil situation is an investigation of the geotechnics and hydrogeology within the area sought for. The focus of this master thesis is on subsidence capacity and the ground water’s pressure levels. Four zones within the hospital area have been pointed out by Region Uppsala for potential future construction projects. The zones are at the parking garage T3, production kitchen, NOP-complex and new cyclotron building. The master thesis was divided into three parts; locating the soil layer sequence, calculation of subsidence based on CRS tests and study of the ground water’s pressure level. The soil layer sequence was construed in GeoSuite based on 474 probes conducted by the consultant company Bjerking. The probs respective soil layer was interpolated and illustrated as level curves using Topocad. Eight cross-sections were made within the zones of extra interest and the sections were made from a 3D-model created in Civil 3D. The soil layers examined throughout the master thesis were filling material, clay, granular soil, rock and ground surface. The subsidence capacity and its time were calculated based on two CRS trials and max-, min- and average values of the ground water’s pressure levels under the hospital area was computed based on 20 years of daily data retrieved from a measuring well in Stadsträdgården facilitated by Uppsala Vatten. The results confirm the ridge complex geology consisting of varying depths of clay under the hospital area. Several buildings will probably require deep foundations, e.g. the parking garage T3. The results also show areas of shallow layers of clay indicating lower risk of subsidence and hence will require a shallow foundation. The conducted subsidence calculations indicate that the parking garage T3 will sink 20 to 70 cm after 158 to 213 years if no foundation is implemented, which is in line with the current subsidence occurring at the building. The ground water’s pressure level has had an average value of + 2.3 m (RH2000) during the last 20 years and will probably not fluctuate in the future due to the existing decision on water management. Hence, some buildings within certain parts of the hospital area will require permission prior to construction within the primary zone.  The results establish a valuable overview of the hydrogeology at Uppsala University Hospital and give indications regarding how the foundations in the zones of extra interest should be dimensioned sustainable and economically. However, more data is needed, e.g. additional probes and CRS trials, to gain an increased complexity of the hospital area in respect to soil layer sequences and subsidence tendency.

Bibliografický záznam WINZBERGEROVÁ, Alžběta. 2015. Odborný a osobnostní profil manažerů kvality fakultních nemocnic v České republice. Praha: Univerzita Karlova, Fakulta humanitních studií, Katedra řízení a supervize v sociálních a zdravotnických organizacích. 85 stran. Vedoucí diplomové práce Mgr. Petr Vrzáček. Abstract The thesis is focused on the quality management in the healthcare organizations. Quality management is perceived as a process or a set of processes, which are coordinated by a responsible person - a quality manager. The thesis summarizes the expert theoretical knowledge about the historical development of the quality requirements, about the quality management systems in healthcare and it introduces the institutional framework of quality and safety in healthcare organizations in the Czech Republic. The emphasis is especially given to the profile and job description of quality managers. The objective of this thesis is to create a professional and personal profile of quality managers working at the Czech university hospitals. The method of data collection used is semi structured interview. The results from the analysis show that quality managers were educated in different fields, but still they have similar personal characteristics. They perceive their job as exhausting, but they keep being...

In 2012, the county of Uppland in Sweden launched a service granting patients online access to their electronic medical record (EMR), including the list of staff who have logged into the record (the “log list”). Patients seem predominantly positive to this service whereas many professionals, physicians specifically, have expressed concerns about, for example, increased risks of threats and violence towards healthcare staff. One year after launch the present study was conducted to examine whether staff whose patients had gained access to online EMRs experienced greater risks of threats and violence, and were exposed to more threats and violence, than those whose patients had not yet gained access. The extent to which professional role, gender, work experience and staff attitudes to the service were important factors was also examined. A total of 174 professionals at Uppsala University Hospital responded to a web survey (35% response rate). 83 represented the emergency department, whose patients had online EMR access, and 91 represented the psychiatric department, whose patients had not. 40% of all participating professionals, emergency physicians and psychiatric staff specifically, believed that risks of threats and violence increase after launch. The results did not, however, support a correlation between patient access to online EMRs and more incidents of threats and violence, and only one respondent reported that patient access had played any significant negative role in relation to an incident. These and other results may prove useful as the online EMR service is now being launched in other Swedish counties as well. / År 2012 infördes inom Uppsala läns landsting en tjänst som ger patienter tillgång till sin journal via nätet, inklusive listan över personal som loggat in i journalen. Patienter har visat sig vara övervägande positiva till tjänsten, medan många vårdgivare, speciellt läkare, har uttryckt farhågor gällandes, till exempel, ökad risk för hot och våld mot vårdpersonal. Ett år efter införandet genomfördes denna enkätstudie med syfte att undersöka om sjukvårdspersonal vars patienter fått tillgång till journal via nätet upplever högre grad av risk för hot och våld samt om de i realiteten är mer utsatta för hot och våld än dem vars patienter inte fått denna tillgång. Även betydelsen av yrke, kön, arbetserfarenhet samt generell attityd till journal via nätet undersöktes i relation till hot och våldsrisker respektive utsatthet för våld. En webundersökning besvarades av 174 anställda vid Akademiska sjukhuset i Uppsala (svarsfrekvens 35 %). 83 representerade den öppna akutvårdsmottagningen, vars patienter hade tillgång till journal via nätet, och 91 representerade de slutenvårdspsykiatriska avdelningarna, vars patienter inte hade denna tillgång. 40 % av respondenterna, speciellt akutvårdsläkare och psykiatrivårdspersonal, trodde att riskerna för hot och våld ökar vid införande av journal via nätet. Resultaten påvisade dock inte någon korrelation mellan patienttillgång till journal via nätet och förekomst av hot- och våldsincidenter och endast en respondent svarade att patienttillgång spelat en betydande negativ roll i relation till en incident. Dessa och andra resultat i studien kan vara av betydelse nu när införanden av journal via nätet sprids även till andra landsting i Sverige.

Introdução. Medicamentos não licenciados e sem indicação são utilizados com grande frequência em pediatria por razões éticas e econômicas. A utilização destes medicamentos não constitui um preceito ilegal, mas pode oferecer risco aos pacientes, sendo responsabilidade do médico e do farmacêutico qualquer evento adverso ocasionado. Alguns estudos nesta população sugerem aumento do risco de reações adversas relacionadas ao uso de medicamentos fora das indicações licenciadas. Objetivo. Analisar a exposição a medicamentos não licenciados e sem indicação em neonatos admitidos em Unidade de Terapia Intensiva (UTINEO) em hospital universitário de média complexidade de São Paulo, Brasil. Método. Estudo descritivo transversal dos medicamentos prescritos nas primeiras 24 horas de internação para 79 pacientes admitidos na Unidade de Terapia Intensiva Neonatal, do Hospital Universitário da Universidade de São Paulo (HU-USP), campus de São Paulo, no período de 12/03/08 a 03/11/08. Os medicamentos foram classificados em não licenciados e sem indicação para utilização por população neonatal de acordo com critérios de registro brasileiros e americanos. Resultados: foram prescritos 346 medicamentos. De acordo com os critérios brasileiros de licenciamento 58% não estavam licenciados, 9,5% não eram indicados, sendo que 66 % dos pacientes foram expostos a ao menos 1 item não licenciado e 18% a pelo menos 1 item sem indicação. A avaliação com base nos critérios americanos demonstrou que 53% dos medicamentos não estavam licenciados, 10,9% não tinham indicação, sendo que 63% dos pacientes foram expostos a ao menos 1 item não licenciado e 20% a pelo menos 1 item sem indicação.Conclusões: Os neonatos brasileiros estão expostos a medicamentos não licenciados e sem indicação nas primeiras 24 horas de internação. Embora esforços tenham sido empregados em diversos países para diminuir tal prática, o problema não foi equacionado. No Brasil, ainda, há informações distintas em bulas de medicamentos licenciados e, em relação, aos medicamentos não licenciados ou sem indicação não há nenhuma política estabelecida. / Introduction. In pediatrics utilization of unlicensed an off-label drugs are a common practice and this account for ethical and economic reasons. The utilization of unlicensed and off label drugs is not illegal, but can expose patients to risk of harm. Physicians and pharmacists have legal responsibility for any adverse event that may result from this use. Some studies in the pediatric field suggest an increased risk to adverse reactions related to unlicensed and off label use. Objective. To assess the exposure to unlicensed and off-label medicines in neonates admitted to the Neonatal Intensive Care Unit (NICU) in a Brazilian medium complexity University Hospital. Materials and Methods. A cross sectional descriptive study was conducted of prescribed medicines in the first 24 hours of admission for 79 patients admitted to the Neonatal Intensive Care Unit (NICU) in the University Hospital of the University of São Paulo (HU-USP), campus of São Paulo in the period of 12/03/08 to 03/11/08. The medicines were classified as unlicensed and off-label for use in neonatal population according to the criteria for licensing of medicines in Brazil and US. Results: There were a total of 346 medicines prescribed and according to the established criteria in Brazil 58% were unlicensed, 9.5% were off-label; 66% of patients were exposed to at least 1 item unlicensed and 18% at least 1 item off-label. In relation to the criteria in USA 53% were not licensed, 10.9% were off-label, and 63% of patients were exposed to at least 1 item unlicensed and 20% at least 1 item off-label. Conclusions: Brazilian neonates are exposed to unlicensed and off-label medicines already in the first 24 hours of hospitalization. Although efforts have been employed in several countries to reduce this practice, the problem was not solved. In Brazil, there is even different information in leaflets for medicines licensed in and, in relation, to unlicensed or off-label medicines there is no established policy.

Made available in DSpace on 2016-04-29T14:16:08Z (GMT). No. of bitstreams: 1 Ana Paula Rocha de Sales Miranda.pdf: 5709819 bytes, checksum: 43ed52ac1f640afaa73cd61dcfdc9716 (MD5) Previous issue date: 2011-11-25 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / This thesis evaluate the work process in public health services with insertion of Social Service, starting from a case study accomplished with Social Assistants of Hospital Universitário Lauro Wanderley (HULW). Total sample was 18 subjects, being 88,89 of this sample evaluated. The purpose of this research was elucidate how the Social Workers organize their activities and what cultural traces of public service and their inflections reflects on socio-occupational space and work. Refer to Social Service work theme starting from centrality of work category as main mediation of man, being in mind that work process are influenced by the organizational culture or professions subcultures. It exposes the work starting from Marxist theory, explicit the work specificities in services and discuss the process of work in health, demonstrating the continuity and possibilities for new conductions, enlighten the reorganization necessity and highlighting the importance of organizational culture that consolidate health care oriented practices, beyond the necessity of culture of public service vice settle that lead to disrespect to the citizens rights, adding, yet, a historical Social Service in health panorama. Enters, in sequence, in the hospital universe, and from that, particularizes the practices of the category in HULW. Four documental research instruments were used, analytical tools of health services elaborated by Franco e Merhy (2003) - "fluxograma" and "rede de petição e compromissos", - questionnaire and interview. From assembling of Social Service ambulatory "fluxograma" and "rede de petição e compromisso" 14 Social Workers and 3 residents of Social Service were enrolled. In the Clinics "fluxograma" 8 professionals and 3 residents were enrolled, being this tools constructed in June. The interviews and questionnaires were applied between June and July, with 15 Social Workers. This study particularizes the analysis of professional practice of the Social Workers, the main accomplished actions and surrounding concepts, available work conditions, as well organizational culture about HULW and interferences that public service culture has over his work and institution. The main results show that this is a vertical, centralized and burocratic-normativ, with practices leaded by irrationality and absence of work cult, giving to the work an aspect of favor, instead of cooperation. The physician is central in the work process, what leads to knowledge isolation and users interests subordination, conditioning the main demands of Social Service to circumscription of the paradox fixed between universal right and restrict access, giving the resolution of barriers from itself, but not as access provider. The importance of emphasis observed in socioeducative actions is highlighted, but also the necessity of internal project elaboration for the category and critical analysis of his actions, in a way to go beyond elaboration of answers for immediate demands of population / Esta tese analisa os processos de trabalho em serviços públicos de saúde nos quais se insere o Serviço Social, a partir de um estudo de caso feito com as assistentes sociais do Hospital Universitário Lauro Wanderley (HULW), cujo universo é de dezoito profissionais do qual se obteve uma amostra de 88,89%. Propôs-se elucidar como as assistentes sociais organizam suas práticas e quais as inflexões ocasionadas pelos traços da cultura do serviço público e pela lógica de organização hospitalar sobre seu espaço sócio-ocupacional e seu trabalho. Refere-se ao tema do trabalho do Serviço Social na saúde a partir da centralidade da categoria trabalho como a principal mediação do homem, entendendo-se que os processos de trabalho são influenciados pelas culturas das organizações ou das subculturas das profissões. Retrata o trabalho a partir da teoria marxista, explicita as especificidades do trabalho em serviços e discute os processos de trabalho na saúde, demonstrando os continuísmos e as possibilidades para novas conduções, enfatizando a necessidade de reorganização dos mesmos e destacando a importância de uma cultura organizacional que consolide práticas voltadas para o cuidado em saúde, além da necessidade de dirimir os vícios da cultura do serviço público que provocam o descuro do direito do cidadão, acrescentando, ainda, um panorama histórico do Serviço Social na saúde. Adentra, em seguida, o universo hospitalar e, a partir daí, particulariza as práticas da categoria no HULW. Utilizou-se quatro instrumentos de pesquisa: pesquisa documental, ferramentas analisadoras dos serviços de saúde elaboradas por Franco e Merhy (2003) fluxogramas e rede de petição e compromissos , questionário e entrevista. Da montagem do fluxograma do Ambulatório e da rede de petição e compromissos do Serviço Social participaram quatorze assistentes sociais e três residentes de Serviço Social, já no fluxograma das Clínicas foram oito profissionais e as três residentes, todos construídos em junho. As entrevistas e questionários foram aplicados entre junho e julho, junto a quinze assistentes sociais. O estudo particulariza a análise da prática profissional das assistentes sociais, as principais ações que realizam e concepções que as cercam, as condições de trabalho de que dispõem, assim como as percepções que tem da cultura organizacional do HULW e as interferências que a cultura do serviço público produz sobre seu trabalho e sobre a instituição. Os principais resultados indicam que esta é uma organização vertical, burocrático-normativa e centralizada, com práticas conduzidas pela irracionalidade e ausência de culto ao trabalho, dando ao trabalho coletivo um cariz de favor e não de cooperação. O médico é central nos processos de trabalho, o que proporciona isolamento dos saberes e subordinação dos interesses dos usuários e condiciona as principais demandas do Serviço Social à circunscrição ao paradoxo fixado entre o direito universal e o acesso restrito, cabendo-lhe a resolução dos entraves relativos ao mesmo, como facilitador, mas não como garantidor do acesso. Destaca a importância da ênfase observada nas ações socioeducativas, mas também a necessidade de elaboração de projeto interno para a categoria e da análise crítica das suas ações, de modo a ir além da elaboração de respostas para as demandas imediatas da população

O presente estudo tem como objeto de análise a readaptação funcional de servidores públicos enquanto uma expressão das condições objetivas de trabalho em um hospital universitário no Brasil e seus possíveis impactos na saúde dos trabalhadores; sendo ainda, momento potencial para análise das possibilidades de reconstrução do trabalho público. Os objetivos da investigação consistem em: identificar através do processo de readaptação funcional se o crescente adoecimento do servidor público seria uma expressão dos impactos do ajuste neoliberal no desmantelamento do Estado, via instituições públicas, precariedade das condições de trabalho e de suas formas de gestão; refletir sobre a intervenção interprofissional voltada para a reinserção do trabalhador ao processo produtivo em função da readaptação funcional e avaliar em que dimensões e processos as tendências de gestão pública, no campo analisado, interferem na saúde dos trabalhadores da área estudada e como poderiam contribuir para a mudança dos seus condicionantes. A metodologia de investigação baseou-se em pesquisa bibliográfica e documental e entrevistas individuais com técnicos da equipe interdisciplinar, gestores e representante sindical e entrevistas em grupo com auxiliares de enfermagem readaptados. O estudo confirmou a relevância da reconstrução do trabalho no serviço público por meio de uma gestão democrática com controle social, garantindo a participação da comunidade em todo o processo, para a definição de uma política institucional, norteada pelos pressupostos da saúde do trabalhador. / The present study has as its object of analysis "job retraining" of public servants as an expression of the objective conditions of work in a university hospital in Brazil and their potential impacts on the health of workers, and yet, when the potential for analysis of the possibilities of reconstruction the public work. The objectives of the research are to: identify through the process of "job retraining" the increasing illness of the public servant would be an expression of the impacts of neoliberal adjustment in dismantling the state by public institutions, precarious working conditions and their ways of management; reflect on interprofessional intervention aimed at the reintegration of the worker in the production process due to the "job retraining" and evaluate which dimensions and processes of public management trends in the field examined, interfere with the health of workers in the study area and how they could contribute to change their conditions. The research methodology was based on literature and documents and interviews with technicians of the interdisciplinary team, managers and union representative and group interviews with nursing assistants "repurposed". The study confirmed the importance of the reconstruction work in the public service through a social democratic management control, ensuring community participation in the whole process, the definition of an institutional policy, guided by the assumptions of worker health.

O presente estudo tem como objeto de análise a readaptação funcional de servidores públicos enquanto uma expressão das condições objetivas de trabalho em um hospital universitário no Brasil e seus possíveis impactos na saúde dos trabalhadores; sendo ainda, momento potencial para análise das possibilidades de reconstrução do trabalho público. Os objetivos da investigação consistem em: identificar através do processo de readaptação funcional se o crescente adoecimento do servidor público seria uma expressão dos impactos do ajuste neoliberal no desmantelamento do Estado, via instituições públicas, precariedade das condições de trabalho e de suas formas de gestão; refletir sobre a intervenção interprofissional voltada para a reinserção do trabalhador ao processo produtivo em função da readaptação funcional e avaliar em que dimensões e processos as tendências de gestão pública, no campo analisado, interferem na saúde dos trabalhadores da área estudada e como poderiam contribuir para a mudança dos seus condicionantes. A metodologia de investigação baseou-se em pesquisa bibliográfica e documental e entrevistas individuais com técnicos da equipe interdisciplinar, gestores e representante sindical e entrevistas em grupo com auxiliares de enfermagem readaptados. O estudo confirmou a relevância da reconstrução do trabalho no serviço público por meio de uma gestão democrática com controle social, garantindo a participação da comunidade em todo o processo, para a definição de uma política institucional, norteada pelos pressupostos da saúde do trabalhador. / The present study has as its object of analysis "job retraining" of public servants as an expression of the objective conditions of work in a university hospital in Brazil and their potential impacts on the health of workers, and yet, when the potential for analysis of the possibilities of reconstruction the public work. The objectives of the research are to: identify through the process of "job retraining" the increasing illness of the public servant would be an expression of the impacts of neoliberal adjustment in dismantling the state by public institutions, precarious working conditions and their ways of management; reflect on interprofessional intervention aimed at the reintegration of the worker in the production process due to the "job retraining" and evaluate which dimensions and processes of public management trends in the field examined, interfere with the health of workers in the study area and how they could contribute to change their conditions. The research methodology was based on literature and documents and interviews with technicians of the interdisciplinary team, managers and union representative and group interviews with nursing assistants "repurposed". The study confirmed the importance of the reconstruction work in the public service through a social democratic management control, ensuring community participation in the whole process, the definition of an institutional policy, guided by the assumptions of worker health.

It is proven that the capacity to form human resources and use them with a view of achieving organization´s objectives is one of the essential factors of business success. Human resource management is the latest policy of the work with personnel and it becomes the most significant component of organization´s management. Healthcare facilities represent specific entities. In connection with the reform measures of health services, privatization of hospitals and other circumstances, a trend has appeared recently to convert healthcare facilities to market entities and operate them on base of market principles. In my thesis I tried to cover and evaluate the process of human resource management in the University Hospital in Pilsen which is the largest healthcare facility of the Pilsem Region. The objective of the thesis was achieved. The thesis can be used by the hospital, especially those employees who are in charge of human resource management, to improve the process. Moreover, it can serve to experts as well as general public to acquire more information and form an idea on the situation of human resource management in a large healthcare facility

One of the key factors influencing the quality of nursing care practice is the research applied within nursing processes. Therefore it is vital for theory to be closely linked with practice. To perform research and apply its results in practice is one of the conditions which lead to the development of evidence-based practice. Research applied in nursing care is a key strategy resulting into the unification of the human educational and scientific aspects of nursing care. This thesis focuses on the nursing care research and its application in practice together with the role of senior nurses within this process. The aim was to investigate whether and how the nurses are actually involved in nursing care research plus to examine whether ordinary nurses are willing to accept any changes associated with the introduction of the results of nursing care research into nursing practice. Besides this, also to determine whether nurses are encouraged to implement the results of nursing research into nursing practice, to observe nursing care deputies and leading nurses experience in respect to the implementation of the nursing care research results into practice in different types of hospitals plus to determine whether and how nurses introduce the results of nursing care research into practice. The final objective of this thesis was to determine whether the head nurses manage to introduce the results of the nursing care research into their nursing practice. In quantitative survey performed, the research sample consisted of nurses who work in inpatient departments at clinics and regional hospitals - public limited companies of the Central, South, West Bohemia, and Prague. 350 questionnaires were distributed. The research involved 186 questionnaires. Qualitative research data collection involved 12 respondents, out of which there were 3 head sisters employed at clinics and 3 nursing care deputies plus 3 head nurses from regional hospitals - public limited companies. All interviews were entirely anonymous. According to the survey findings, most of the nurses replied that they are not actively involved in the nursing care research. Nurses generally follow published results of nursing care research, but on the other hand, it is obvious, that they follow nursing care research outcomes randomly and without particular focus. Nurses not only that they refuse any changes, but they do not see any benefits of the implementation of research findings into the nursing care practice. The qualitative survey performed met objectives and all questions were answered. Any of the responses can serve for further quantitative research, especially when the results of the implementation of the nursing care research into practice at clinics and regional hospitals are compared.

Introdução. Medicamentos não licenciados e sem indicação são utilizados com grande frequência em pediatria por razões éticas e econômicas. A utilização destes medicamentos não constitui um preceito ilegal, mas pode oferecer risco aos pacientes, sendo responsabilidade do médico e do farmacêutico qualquer evento adverso ocasionado. Alguns estudos nesta população sugerem aumento do risco de reações adversas relacionadas ao uso de medicamentos fora das indicações licenciadas. Objetivo. Analisar a exposição a medicamentos não licenciados e sem indicação em neonatos admitidos em Unidade de Terapia Intensiva (UTINEO) em hospital universitário de média complexidade de São Paulo, Brasil. Método. Estudo descritivo transversal dos medicamentos prescritos nas primeiras 24 horas de internação para 79 pacientes admitidos na Unidade de Terapia Intensiva Neonatal, do Hospital Universitário da Universidade de São Paulo (HU-USP), campus de São Paulo, no período de 12/03/08 a 03/11/08. Os medicamentos foram classificados em não licenciados e sem indicação para utilização por população neonatal de acordo com critérios de registro brasileiros e americanos. Resultados: foram prescritos 346 medicamentos. De acordo com os critérios brasileiros de licenciamento 58% não estavam licenciados, 9,5% não eram indicados, sendo que 66 % dos pacientes foram expostos a ao menos 1 item não licenciado e 18% a pelo menos 1 item sem indicação. A avaliação com base nos critérios americanos demonstrou que 53% dos medicamentos não estavam licenciados, 10,9% não tinham indicação, sendo que 63% dos pacientes foram expostos a ao menos 1 item não licenciado e 20% a pelo menos 1 item sem indicação.Conclusões: Os neonatos brasileiros estão expostos a medicamentos não licenciados e sem indicação nas primeiras 24 horas de internação. Embora esforços tenham sido empregados em diversos países para diminuir tal prática, o problema não foi equacionado. No Brasil, ainda, há informações distintas em bulas de medicamentos licenciados e, em relação, aos medicamentos não licenciados ou sem indicação não há nenhuma política estabelecida. / Introduction. In pediatrics utilization of unlicensed an off-label drugs are a common practice and this account for ethical and economic reasons. The utilization of unlicensed and off label drugs is not illegal, but can expose patients to risk of harm. Physicians and pharmacists have legal responsibility for any adverse event that may result from this use. Some studies in the pediatric field suggest an increased risk to adverse reactions related to unlicensed and off label use. Objective. To assess the exposure to unlicensed and off-label medicines in neonates admitted to the Neonatal Intensive Care Unit (NICU) in a Brazilian medium complexity University Hospital. Materials and Methods. A cross sectional descriptive study was conducted of prescribed medicines in the first 24 hours of admission for 79 patients admitted to the Neonatal Intensive Care Unit (NICU) in the University Hospital of the University of São Paulo (HU-USP), campus of São Paulo in the period of 12/03/08 to 03/11/08. The medicines were classified as unlicensed and off-label for use in neonatal population according to the criteria for licensing of medicines in Brazil and US. Results: There were a total of 346 medicines prescribed and according to the established criteria in Brazil 58% were unlicensed, 9.5% were off-label; 66% of patients were exposed to at least 1 item unlicensed and 18% at least 1 item off-label. In relation to the criteria in USA 53% were not licensed, 10.9% were off-label, and 63% of patients were exposed to at least 1 item unlicensed and 20% at least 1 item off-label. Conclusions: Brazilian neonates are exposed to unlicensed and off-label medicines already in the first 24 hours of hospitalization. Although efforts have been employed in several countries to reduce this practice, the problem was not solved. In Brazil, there is even different information in leaflets for medicines licensed in and, in relation, to unlicensed or off-label medicines there is no established policy.