Cardiovascular disease is a major killer worldwide and it is becoming clear the significance of our diet in curbing the disease. Green tea is one of the most widely consumed beverages in the world and has recently attracted significant attention in the scientific community for its health benefits. Its consumption has been associated with lower incidences of coronary artery diseases in the Japanese population. This is mainly attributed to its polyphenolic constituents that include epicatechin, epicatechin gallate, epigallocatechin and epigallocatechin gallate. The aim of this research was to synthesise the four major polyphenols present in green as well as analogues. These compounds would then be tested on H9C2 cardiac myoblast cells and neonatal rat cardiomyocytes in order to further understand the structure-activity relationship as well as potentially improve the cardioprotective function of these polyphenols following oxidative stress and ischaemia/reperfusion injury focusing on the expression of STAT-1 and ERK-1/2 proteins. In H9C2 cardiac myoblast cells following the induction of oxidative stress using H2O2, EGCG, EGC and to a minor extent ECG inhibited STAT-1 activation but not ERK- 1/2 phosphorylation suggesting that although the ERK-1/2 pathway gets activated, its downstream activation of STAT-1 is inhibited by the above polyphenols. EC, on the other hand, inhibited ERK-1/2 activation which in turn cannot activate STAT-1. Quantitative assessment of viable cells showed that pretreatment with EGCG resulted in the lowest amount of non-viable cells reducing cell death by 30%. With neonatal rat cardiomyocytes following ischaemia/reperfusion injury, pretreatment with EGCG reduced the amount of non viable cells by 5% but pretreatment with acetylated EGCG at half the concentration of EGCG reduced non-viable cells by 8%. Structure-activity relationships of the green tea polyphenol analogues identified some key aspects in the structures of the polyphenols important in their cardioprotective function. Results indicated that ABD ring system is required for cardioprotective function but the presence of a third OH group in the ring may not be necessary. Substitution of ring C with benzoic and naphthoic rings improved the potency by more than 13-fold compared to EGCG with EC50 values of 1.60 and 0.77 μM respectively. Further research into these analogues could realise their potential and contribute to the understanding of the cardioprotective activities of green tea. A review on the previous synthesis approaches, isolation and biosynthesis of the green tea polyphenols is presented in Chapter 1 and also the different signalling pathways of interest in this work. An evaluation of the biological activities of the four major polyphenols is provided in Chapter 3. Experimental procedure and characterisation data are in Chapter 5.

This thesis describes the synthetic work towards the natural product Chrysophaentin F which has been extracted from the alga Chrysophaeum taylori. This bisdiarylbutene macrocycle exhibits antimicrobial properties against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VREF) (MIC50 (MRSA) = 4.2 ± 1.3 μg/mL). Investigation of the key steps on an unchlorinated analogue allowed us to determine what strategy would be best to access the natural product. The formation of the desired core structure relied on a Chan-Lam-Evans coupling reaction, a Pd catalysed coupling reaction and a RCAM reaction to create the pivotal bonds of the complex scaffold. The investigation on a model system to form the vinyl chloride bridge has also been performed bringing insight on the possible regioselectivity of the necessary late stage hydrochlorination reaction. Finally the synthesis towards the chlorinated macrocycle was started and advanced enough to access some key intermediates which despite some unforeseen difficulties proved that the natural product is now at reach following the strategy developed for the unchlorinated analogue.

Whilst the interest in open innovation is growing, thus far few studies have emphasised its importance beyond hi-tech industries and large multinationals. This research aims to generate an understanding of open innovation adoption within the UK Bio-pharmaceutical industry, which is chosen because of the significant growth it has experienced in recent times, and is heavy reliance on R&D. The findings of this multi-level study present a holistic view of the opportunities and barriers pertaining to open innovation in Biopharmaceutical SMEs and large firms, as well as indicating that open innovation strategies assist firms’ in terms of value creation and capture. The study also illustrates that strategies cannot necessarily be regarded as explicitly open or closed innovation, as there is a significant spectrum of approaches in the space between. The study’s theoretical contribution develops the use of critical realism, a scientific reality which is not only about constant combinations of observable events but is also about individuals, entities and structures that exist and generate the events we witness and observe. In doing so, the study utilises an alternative to inductive or deductive reasoning, the retroductive reasoning. Through retroduction, the study to explain these causal powers, mechanisms, as well as the contingent relations of individuals that are responsible for the creation of a firm’s strategic considerations based on a multi-layered approach (micro-with individuals/meso-with various organisations/macro-with various government bodies and organisations). The study comprises three sets of results, focusing on CEOs, knowledge brokers and senior executives respectively. The first set of results, based on 30 interviews of CEOs in Small-to-Medium sized Enterprises (SMEs), suggests that i open innovation practices are utilised in a multi-level, but that not all SMEs adopt the open concept. This shows the reluctance of CEOs in SMEs in sharing internal information and intellectual property. The second set, obtained from interviews with 8 Knowledge Brokers in the industry, emphasised the need for an agenda when open practices are utilised and there are personal preconceptions regarding business, which are in many cases difficult to change or adjust during open approaches. The third set, obtained from a survey questionnaire with 12 executives of 10 large biopharmaceutical firms, illustrates the importance their firms place on open innovation practices, particularly in collaborating with various firms and organisations. In spite of the industry’s recent efforts, the study identifies that benefits from the adoption of open innovation are yet to be seen, as the realisation of research and development outcomes within the Biopharmaceutical sector is a long process. Furthermore, the study clarifies that open innovation is not a monopoly of large firms in the high-tech sector, but can be adopted in various other firms in different industries. Additionally, this study contributes to the expansion of multi-layered approaches, as they give a thorough view of the processes that are involved during open innovation adoption. Finally, the research addresses the lack of empirical work in open innovation and suggests methods that identify how and why particular processes are utilised when open strategies are adopted, and elucidates the space between closed and open innovation.

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em Enfermagem. / Made available in DSpace on 2012-10-26T05:53:04Z (GMT). No. of bitstreams: 1 299963.pdf: 3817695 bytes, checksum: 61efb7853a18ffd59942f69c2d665bcb (MD5) / A doença Influenza é conhecida há centenas de anos, mas apesar disto, e de atualmente existir uma vacina comprovadamente eficaz para sua prevenção, continua sendo uma das principais causas de morbimortalidade e gastos financeiros com saúde no mundo. Nos hospitais, a vacinação contra Influenza dos profissionais de enfermagem, reveste-se em fator de biossegurança não só para os mesmos, mas também para os pacientes vulneráveis sob seus cuidados. Este estudo tem como objetivos: fazer o diagnóstico da situação vacinal em relação à Influenza dos profissionais de enfermagem do Hospital Universitário da Universidade Federal de Santa Catarina (HU/UFSC); identificar as crenças e conhecimentos que os profissionais da Diretoria de Enfermagem (DE/HU/UFSC) possuem a respeito deste assunto; estimular a prática da biossegurança através da vacinação dos servidores de enfermagem do HU/UFSC mediante a construção de uma cartilha educativa e, elaborar uma proposta de protocolo para obtenção de cobertura adequada permanente desta vacina. Métodos: O estudo inicialmente tomou como referência o perfil dos vacinados e não vacinados na Campanha Anual de Vacinação contra Influenza 2010. Em seguida calculou-se amostra (n = 265) representativa das categorias: enfermeiro, técnico e auxiliar de enfermagem da DE/HU/UFSC, suficiente para medir com 95% de confiança para as prevalências esperadas. Todos os 265 profissionais selecionados por sorteio responderam a um formulário baseado no Modelo de Crenças em Saúde. A partir das respostas obtidas, foi elaborado e analisado um Banco de Dados nos programas estatísticos Epidata 3.1 e EpiData Analysis, respectivamente. Os achados mais significativos foram tomados como referência para implementação de: (1) Ações educativas, que iniciaram com a elaboração de uma cartilha intitulada "Influenza/Gripe - O Profissional da Saúde precisa Saber" e, incluíram também, Oficinas de Sensibilização, cursos de capacitação e treinamento de vacinadores. (2) Ações administrativas institucionais que culminaram com o detalhamento organizacional da Campanha Anual de Vacinação contra Influenza no formato de um Protocolo e, (3) Ações políticas, através do envolvimento dos órgãos gestores da instituição a fim de sancionar e viabilizar e efetividade das ações propostas visando a Campanha de Vacinação contra Influenza 2011 e posteriores. Resultados: A cobertura vacinal encontrada na instituição foi de 49,8% em 2009, 92,4% em 2010 e 95,4% em 2011. A adesão encontrada foi ligeiramente maior no sexo feminino (92,8%), entre os separados/divorciados (95,0%), na faixa etária entre 41-50 anos (96,5%), nos formados há mais de 20 anos (94,9%), nos que trabalham há mais de 20 anos na instituição (94,0%), nos que atuam na emergência (94,9%), naqueles que possuem mais de um vínculo empregatício (92,6%), nos que não co-habitam com crianças (95,5%), não co-habitam com idosos (93,3%), naqueles que co-habitam com doentes crônicos (95%), possuem nível médio de instrução. Este profissional se vacinou em seu próprio setor de trabalho motivado por uma atitude de auto-proteção. Além disso, este profissional crê na severidade e transmissibilidade da doença para si e para os pacientes sob seus cuidados. Acredita ainda nos benefícios gerados pela vacinação contra Influenza. Este estudo resultou ainda na elaboração, impressão e distribuição para todo o corpo de enfermagem do HU/UFSC da Cartilha "Influenza/Gripe - O Profissional da Saúde Precisa Saber" e também na construção e impressão de um "Protocolo para Adesão dos Servidores de Enfermagem à Vacinação contra Influenza a ser usado na instituição". Considerações Finais: Os achados de cobertura de 92,5% em 2010 e de 95,4% em 2011, considerados excepcionais dentro da atual realidade mundial, refletem a existência de uma cultura de biossegurança relacionada a este tema, incorporada ao longo de uma década de ações educativas, de divulgação e acessibilidade. A construção da cartilha educativa e do protocolo, pretende, contribuir não só para a manutenção e sedimentação dessa cultura dentro da instituição, mas, também, de outros hospitais que desejem organizar/estruturar seus serviços de vacinação. / Influenza is known to humanity for hundreds of years, but despite this and the existence of a provenly effective vaccine for its prevention, the disease continues to be one of the main sources of morbidity and mortality and financial expenses in the world of healthcare. In hospitals, the vaccination against influenza for nursing professionals is a factor of biosecurity not only for nurses, but also for the vulnerable patients under their care. This study has the following objectives: diagnose the situation of flu vaccination among nursing professionals at the university hospital at the federal University at Santa Catarina (HU/UFSC); identify the beliefs and knowledges that the professionals of the department of nursing at the (DE/HU/UFSC) have about this issue; stimulate the practice of biosecurity through vaccination of nursing employees at HU/UFSC through the development of an educational primer and, prepare a proposed protocol to obtain permanent suitable coverage of this vaccine. Methods: The study initially used as a reference the profile of those vaccinated and not vaccinated in the annual Vaccination Against Influenza Campaign 2010. It then calculated a representative sample (n=265) of the categories: nurses, nurse technicians and nursing assistants at the DE/HU/UFSC, sufficient for measuring with 95% reliability the expected prevalences. All of the 265 professionals selected randomly responded to a formula based on the Model of Healthcare Beliefs. From the responses obtained, a database was prepared and analyzed using the statistical programs Epidata 3.1 and EpiData Analysis respectively. The most significant findings were used to guide the implementation of: (1) Educational actions, which were initiated with the primer named "Influenza/Flu - The Healthcare Professional Must Know" and included, too, Sensibilization Workshops, capacitation courses and training for the vaccinators. (2) Institutional administrative actions that resulted in the organizational detailing of the Annual Vaccination Campaign against the Influenza in the format of a Protocol and, (3) Political actions, through the involvement of the institutional manager sectors to approve the proposed actions aiming the Influenza Vaccination Campaign 2011 and posterior campaigns. Results: The coverage of the vaccine found at the institution was 49.8% in 2009, 92.4% in 2010 and 95.4% in 2011. The profile of the professional most adherent to the campaign is slightly greater in females (92.8%), divorced (95.0%), from 41-50 years old (96.5%), graduated for more than 20 years (94.9%), has been working for more than 20 years in the institution (94.0%), work in the Emergency Sector (94.9%), has more than one job, (92.6%), does not live with children (95.5%), does not live with elderly (93.3%), lives with chronical sick people (95.0%), has average level of education. This professional was vaccinated within his work sector, motivated by an attitude of self-protection. He recognizes the severity and transmissibility of the disease to herself and to patients under her care. She also believes in the benefits generated by the flu vaccine. This study resulted in the development, printing and distribution to all nursing professionals from HU/UFSC of the Primer "Influenza/Flu - The Healthcare Professional Must Know" and also the construction and printing of a "Protocol to Adherence of the Nursing Professional to the Vaccination against Influenza to be used in the institution". Final considerations: The findings of coverage of 92.5% in 2010 and of 95.4% in 2011 were considered exceptional within the current global reality, and reflect the existence of a culture of biosecurity related to this issue, incorporated over a decade of activities aimed at education, promotion and accessibility. The construction of the educative primer and the protocol intends to contribute not only to maintain and sediment this culture in the institution, but also in other hospitals that wish to organize their vaccination services.

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Sócio-Economico, Programa de Pós-Graduação em Serviço Social, Florianópolis, 2015. / Made available in DSpace on 2015-11-10T03:05:42Z (GMT). No. of bitstreams: 1 335627.pdf: 1385385 bytes, checksum: f630d6bb47678b471a6a0c62019058be (MD5) Previous issue date: 2015 / Esta pesquisa teve como objetivo identificar as estratégias de acesso da população adulta em situação de rua aos serviços de saúde de Florianópolis. Com vistas ao cumprimento do objetivo proposto a pesquisa contou com a revisão de literatura e levantamento bibliográfico para construção da fundamentação teórica. E, nesta direção, pautou-se em algumas das obras de Karl Marx, e, em autores que desenvolveram suas análises a respeito da forma de estruturação da sociedade capitalista tendo como referencial a teoria crítico dialética, tais como, Mézaros (2009), Antunes (1996), Castel (2008), Faleiros (1991) e Iamamoto (2001; 2004 e 2006). O movimento de resgate das obras dos autores supracitados permitiu a análise do fenômeno da população em situação de rua sob a perspectiva da totalidade. Com vistas ao aprofundamento do debate proposto o presente estudo pautou-se ainda, nas obras de importantes autores que analisam a temática da população adulta em situação de rua no Brasil, tais como, Bulla et al (2004), Escorel (1999), Ferreira e Machado (2007), Kasper (2006), Nasser (2001) Prates et al. (2004; 2011), Varanda e Adorno (2004), Silva (2009). E ainda, alguns autores que abordam a temática no que concerne à especificidade do âmbito da saúde: Adorno (2011), Aristides e Lima (2009), Bottil et al. (2009) e Junior et al. (1998). Na metodologia da pesquisa foi utilizada a técnica de entrevistas semiestruturadas, cuja amostragem seguiu o critério da acessibilidade e de inclusão progressiva. No que diz respeito a análise dos dados, buscou-se trabalhar a partir da abordagem crítico dialética, marxista. Para tanto, a pesquisa procurou primeiramente empreender um estudo acerca das condições sócio-históricas que permeiam a chamada situação de rua, o que, levou a compreender esta população enquanto um fenômeno social urbano que tem sua gênese e agravamento junto ao surgimento e desenvolvimento do sistema de produção capitalista. Foi possível ainda, constatar que a população em situação de rua constitui-se enquanto fenômeno complexo, multifacetado e multideterminado, compreendido enquanto processo de rualização que se estabelece a partir de um conjunto de relações sociais; estigmas; situações sócio-econômicas de precariedade e miséria; desemprego; rompimento ou fragilização de vínculos familiares; situações de violência e exploração; enfim de umconjunto de fatores que se gestam e solidificam no espaço doméstico permeado por relações sociais influenciadas por uma série de condicionantes que, podem levar à situação de rua. Com relação ao acesso deste segmento populacional à Política de Saúde concluiu-se que os serviços de emergências hospitalares são utilizados como principais portas de entrada ao atendimento à saúde em sentido ampliado. Entretanto, foram identificados também alguns entraves a este acesso relacionados principalmente ao preconceito e estigma social vivenciado por esta população.<br> / Abstract : This research aimed to identify the access strategies of the adult homeless population to the health services of Florianopolis. In order to accomplish the proposed objective, the research included a literature review and bibliographical research to build the theoretical foundation. And, in this direction, the study was based on some of the works of Karl Marx and authors who have developed their analyzes of the form of structure of capitalist society using the critical-dialectical theory as a reference, such as Mézaros (2009), Antunes (1996 ) Castel (2008), Faleiros (1991) and Iamamoto (2001; 2004; 2006). The rescue of the works of these authors allowed the analysis of the phenomenon of the homeless population from the perspective of the whole. Aiming at deepening the proposed debate, this study was also based in the works of important authors who analyze the theme of the adult population on the streets in Brazil, such as Bulla et al. (2004), Escorel (1999), and Machado Ferreira (2007), Kasper (2006) Nasser (2001) Prates et al. (2004; 2011), Balcony and Adorno (2004), Silva (2009), as well as some authors that address the issue concerning the specificity of the health context: Adorno (2011), Aristides and Lima (2009), Bottil et al. (2009) and Junior et al. (1998). In the methodology of the research, we used the technique of semi-structured interviews, ans its sample followed the criteria of accessibility and the gradual inclusion. With regard to data analysis, we tried to work from the marxist critical-dialectical approach. Thus, the research first sought to undertake a study on the socio-historical conditions that permeate the so-called street situation, which led to understand this population as an urban social phenomenon that has its genesis and worsening with the emergence and development of the capitalist production system. It was also possible to see that the homeless population is constituted as a complex phenomenon, multifaceted and multidimensional, understood as a process of streetlization that is established from a set of social relations; stigmas; socioeconomic situations of precariousness and poverty; unemployment; breaking or weakening of family ties; violence and exploitation, in short, from a set of factors that are bore and solidified in the domestic space permeated by social relations influenced by a variety of conditions that can lead to homelessness. Regarding the access of this population tohealth policies, it was concluded that the hospital emergency services are used as main entry points to healthcare in extended sense. However, we also identified some barriers to such access primarily related to the prejudice and social stigma experienced by this population.

Drugs that are preferentially absorbed through the stomach or the small intestine have a narrow time window for absorption since passage through this region of the gastrointestinal tract is rapid. A drug delivery system that can adhere to the gastric epithelium will substantially slow down drug transit and help overcome this problem. To achieve this, this study proposes the novel use of a glycan-binding adhesion protein from Helicobacter pylori, BabA, to create targeted drug delivery vectors that can mimic the attachment of this bacterium to the gastric epithelium. In this work, a recombinant form of BabA was expressed in the periplasmic space of Escherichia coli; it was found that after the incorporation of a C-terminal hexa-lysine tag, the expression and purification of this protein was significantly improved to amounts that enabled its subsequent characterisation and application. Recombinant BabA retained the highly selective glycan-binding properties of H. pylori and next, its crystal structure was solved in the absence and presence of Lewisb – a glycan well studied for its role in serving as a receptor for BabA. The structural models revealed that Lewisb binding occurred through a network of hydrogen bonds within a single, shallow binding pocket at the tip of a β-unit in BabA. Binding studies then confirmed that this site was also responsible for the recognition of other glycan receptors. Using this insight, recombinant BabA was conjugated to model drug delivery vectors via a linkage that favoured exposure of its glycan-binding β-unit; the binding properties of BabA successfully translated to these model BabA-vectors. The research presented in this thesis lays a strong foundation for future work to assess the in vitro and in vivo efficacy of biomimetic BabA drug carriers.

Ganoderma lucidum also known as lingzhi or mushroom of immortality in East Asia countries, has been known for over 2000 years. Ganoderic acids (GA), which are important secondary metabolites of this mushroom, are highly oxygenated lanostane-type entities with extraordinary pharmacological properties. GA are biosynthesised from lanosterol by a still unknown mechanism. The synthesis of thirteen GA analogues and the biological evaluation of ten of them against prostate cell-lines is described in this thesis. Analogues with different functionalities at C-3, C-7, C-8, C-9, C-11, C-23, C-24, C-25 and C-26 of the lanostane frame have been synthesised. As functional groups, alcohols, acetates, ketones, carboxylic acids and single and conjugated double bonds have been introduced. For their preparation, aldehyde 89 was formed from commercial lanosterol in up to 47% overall yield over a 3 or 4 step sequence. Wittig olefination, Reformatsky reaction and direct oxidation of aldehyde 89 provided the precursors from which the analogues were achieved. Analogues were prepared after a total of six to eight steps in 7-44% overall yield. GA and their analogues inhibited the cell viability of prostate cell-lines. However, they were less effective in the inhibition than Taxotere® (docetaxel). Besides, by comparing their IC50 values and thus, building a structure activity relationship (SAR) analysis, the most important positions for activity were determined. Interestingly, some of the ganoderic acids, GA-H (24), and analogues 3-ketone 108 and 7,11-diketone 146, were less toxic for the normal prostate cells than for the pre-malignant ones, conferring on them prophylactic activity. It is believed that ketones at C-3, C-7 and C-11 could be responsible for this behaviour. Ganoderma lucidum is rare in nature. However, due to its great demand, it is now being farmed. For their cultivation sawdust, logs or cork is used. New substrates, otherwise disposed as waste, are being investigated to produce high quality mushrooms, among them oil palm fibres such as mesocarp or empty fruit bunch fibres. Therefore, to unveil new cultivation methods, the triterpene composition of the mushroom grown at different stages, with different substrates or conditions has been assessed and their biological activity evaluated against prostate cancer cell-lines. Cultivating the mushroom in mesocarp or empty fruit bunch fibres produced similar results to those of sawdust. However, poor ventilated conditions reduced their biological activity against prostate cancer cell-lines. Likewise, it was established that triterpene composition varied during different stages and for different target body parts, their biological activity also varied with age, increasing as the mushroom aged during the 2- to 8-week period studied.

In order to develop novel antibacterial therapies that combine anti-adhesion, anti-quorum sensing and the delivery of conventional antibiotics, the effects of polymers on bacterial aggregation and quorum sensing (QS) were studied. QS is a term used to describe method by which bacteria use chemical signal molecules to modulate pre-infection behaviour such as surface attachment. Polymers that can interfere with bacterial adhesion or the signal molecules used for QS are therefore a potential means to control bacterial population responses. In this thesis, the ability of the cationic polymers poly (N-[3-(dimethylamino) propyl] methacrylamide) (p(DMAPMAm), P1) and poly (N-dopamine methacrylamide-co-N-[3-(dimethylamino) propyl] methacrylamide) (p(DMAm-co-DMAPMAm), P2) to cluster a range of bacteria, such as Staphylococcus aureus(Gram-positive), Vibrio harveyi, Escherichia coli and Pseudomonas aeruginosa(Gram-negative) under conditions of varying pH and polymer concentration was investigated. It was identified that clustering ability was strongly dependent on the balance between charge and hydrophobicity. The results also suggested that catechol moieties might have a positive effect on adhesive properties. Moreover, the potency of polymers against QS of Vibrio harveyi was assayed via testing bioluminescence. P1 which was able to bind to the surface of bacteria through electrostatic interactions enhanced the expression of QS and P2 which could bind to both the bacteria and QS signals showed the ability to both enhance and reduce light production. Furthermore, polymeric vesicles made of copolymers containing poly (3,4-dihydroxy-L-phenylalanine methacrylamide) (p(L-DMAm)) which displayed similar dual affinity compared toP2 were prepared and their ability to modulate QS responses in Vibrio harveyi was demonstrated. All the vesicles showed higher potency in quenching bioluminescence than their linear polymer analogues. To explore the feasibility of using self-assembled polymers for anti-microbial drug delivery, silver loaded DOPG lipid vesicles were made and were found to interfere with QSwhile reducing bacterial viability when the concentration of Ag+ was above the MIC (0.1 μg/mL). The results overall suggested that combined antimicrobial therapies might be possible using polymers and both QS and cytostatic or cytotoxic agents.

Dissertação (mestrado profissional) - Universidade Federal de Santa Catarina, Programa de Pós-Graduaçao em Gestão do Cuidado em Enfermagem, Florianópolis, 2013. / Made available in DSpace on 2014-08-06T17:47:09Z (GMT). No. of bitstreams: 1 326184.pdf: 1597891 bytes, checksum: 4abeef0f3fcf03503edb493d8c2f00c6 (MD5) Previous issue date: 2013 / O diagnóstico de qualidade deficitária e insegura da assistência de enfermagem no setor de terapia intensiva, acrescido de insatisfação de trabalhadores impulsionou a investigação da carga de trabalho de enfermagem. A identificação da carga de trabalho é mensurada com uso de instrumentos de avaliação do usuário e características do serviço prestado. O Instrumento de Avaliação do Grau de Dependência dos Usuários e o Nursing Activities Score foram utilizados para o objetivo de construir subsídios para a escolha do método de medida da carga de trabalho e dimensionamento que melhor se adeque às características da Unidade de Terapia Intensiva, a partir da comparação dos dois instrumentos de avaliação. Os objetivos específicos incluem identificar a carga de trabalho da enfermagem segundo os indicadores do Instrumento de Avaliação do Grau Dependência dos Usuários, e segundo as atividades e intervenções terapêuticas do Nursing Activities Score; comparar os instrumentos propostos para identificação da carga de trabalho e projetar o dimensionamento de pessoal de enfermagem, de acordo com o Nursing Activities Score. Estudo retrospectivo, quantitativo, exploratório-descritivo correlacional, desenvolvido em unidade de terapia intensiva adulto do Sul do Brasil. A população foi constituída pelos usuários que consentiram participar, internados na unidade do primeiro ao trigésimo dia do mês de julho de 2013. A coleta de dados correspondeu a trinta dias consecutivos com consulta aos registros de enfermagem das últimas 24h. A análise de dados foi realizada mediante estatística descritiva, aplicação do Teste-t e Correlação de Pearson com nível de significância de 5%. Foram realizadas 374 avaliações de 56 usuários, com variação entre 19 e 85 anos e permanência média de 6,67 dias (mediana de 3 dias) de internação, taxa de ocupação de 89% para 14 leitos. As horas aplicadas por categoria de cuidado foram: mínimo 3,8h, cuidado intermediário 5,6h, alta dependência 12h, semi-intensivo 9,4h e para cuidado intensivo 17,9h. As horas individuais requeridas, identificadas pelo Nursing Activities Score e Instrumento de Avaliação do Grau de Dependência dos Usuários, pareadas, apresentam correlação moderada, sendo as médias por usuário de 13,4(±3,26) e 15(±3,7) horas, respectivamente. O Instrumento de Avaliação do Grau de Dependência dos Usuários considera aspectos psicobiológicos e psicossociais em 16 indicadores de avaliação. O escore total representa a necessidade de assistência direta ao usuário, estratificado em categoria de necessidade de cuidado. O Nursing Activities Score tem sete categorias subdivididas em 23 tópicos de avaliação. Cada tópico é pontuado ou não, de acordo com a necessidade, sendo o escore final corresponde à porcentagem de tempo requerido de assistência direta e indireta por usuário, no período avaliado. O quantitativo de profissionais de enfermagem existente versus a projeção necessária demonstra disponibilidade de pessoal suficiente para atender a demanda dos usuários, divergente em relação às proporções por categoria profissional. O quadro de pessoal projetado pela Resolução Diretoria Colegiada nº 26 geraria um quantitativo insuficiente para atender as demandas identificadas. A utilização de um Sistema de Classificação de Necessidades de Cuidados de Enfermagem é previsto nas regulamentações dos serviços de saúde, sendo imprescindível a implementação de um instrumento para terapia intensiva. O estudo apontou que ambos os instrumentos utilizados têm compatibilidade com terapia intensiva. A melhoria da qualidade e segurança da assistência de enfermagem frente ao dimensionamento de pessoal adequado segue com reflexões para novas investigações, manejo do absenteísmo e melhora do estado de ânimo da equipe. Novas investigações são necessárias para identificação dos fatores que influenciam a carga de trabalho, bem como ampliação da utilização e validação do Instrumento de Avaliação do Grau de Dependência dos Usuários.<br> / Abstract : The diagnosis of quality deficiencies and insecure of nursing care in the intensive care unit, plus dissatisfaction of workers impelled the investigation of nursing workload. The ID of the workload is measured with use of user assessment tools and features of the service. The Instrument for Assessment of the Degree of Dependence of the Users and the Nursing Activities Score; were used for the purpose of building subsidies for choice of method of measurement of the workload and dimensioning which best suits the requirements of the Intensive Care Unit, from the comparison of two evaluation tools. The specific objectives include identifying the nursing workload according to the indicators of the Instrument for Assessment of the Degree of Dependence of the Users, and according to the users activities and therapeutic interventions of Nursing Activities Score; compare the proposed instruments for identification of workload and project the dimensioning of nursing staff, according to the Nursing Activities Score. Retrospective study, quantitative, exploratory-descriptive correlational, developed in adult intensive care unit in southern Brazil. The population was constituted by users who have consented to participate, hospitalized in the unit from the first to the thirtieth day of the month of July 2013. Data collection accounted for thirty consecutive days with consulting the nursing records of the last 24 hours. Data analysis was performed by descriptive statistics, application of the T-test and Pearson's Correlation with a significance level of 5%. 374 evaluations of 56 users were performed, with variation between 19 and 85 years and average stay of 6.67 days (median 3 days) of hospitalization, occupancy rate of 89% to 14 beds. The hours applied by category of care were: minimum 3.8h, intermediate care 5.6h, high dependency 12h, semi-intensive 9.4h, and for intensive care 17.9h. The individual hours required, identified by the Nursing Activities Score and Instrument for Assessment of the Degree of Dependence of Users, paired, present moderate correlation, and averages per user 13.4(±3.26) and 15(±3.7) hours, respectively. The Instrument for Assessment of the Degree of Dependence Users considers psychobiological and psychosocial aspects in 16 evaluation indicators. The total score represents the need for direct assistance to the user, storied in category of need for care. The Nursing Activities Score has seven categories subdivided into 23 evaluation topics. Each topic is scored or not, according to the need, being the final score corresponds to the percentage of time required of direct and indirect assistance per user, during the assessed period. The amount of existing nursing professionals versus the necessary projection demonstrates the availability of sufficient staff to attend the demand of users, diverging in relation to the proportions by professional category. The staff designed by the Collegiate Board Resolution No. 26 would generate an insufficient quantity to attend identified demands. The use of a Classification System of Nursing Care Needs is provided in the regulations of the health services, being essential to the implementation of an instrument for intensive therapy. The study pointed out that both instruments have compatibility with intensive therapy. The improvement of the quality and safety of nursing care in front of the appropriate staff dimensioning continues with reflections for new researches, management of absenteeism and improves the mood of the team. New investigations are necessary to identify the factors that influence the workload, as well as expanding the use and validation of the Instrument for Assessment of the Degree of Dependence of the Users.

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico, Programa de Pós-Graduação em Engenharia Elétrica, Florianópolis, 2014. / Made available in DSpace on 2015-02-05T20:27:32Z (GMT). No. of bitstreams: 1 327777.pdf: 1442169 bytes, checksum: 09b9bdaf11643a103bc6c9ce1494d332 (MD5) Previous issue date: 2014 / As ações e tendências da Engenharia Clínica (EC) são fortemente influenciadas pelo processo tecnológico em saúde. Por meio da gestão da tecnologia médico-hospitalar a EC pode contribuir com metodologias para todas as fases do ciclo de vida das tecnologias. No propósito de atender às variações do ciclo de vida foi elaborada uma metodologia para o gerenciamento de equipamentos médico-assistenciais (EMAs) em fase de utilização. Esta proposta está fundamentada em um modelo estrutural para analisar a confiabilidade de EMAs. O modelo constitui-se de três módulos: coleta dos dados, análise estatística e apoio à tomada de decisão. Para demonstrar a aplicação da metodologia elaborada, um estudo de caso foi realizado em sete estabelecimentos assistenciais à saúde. Este estudo foi direcionado à aplicação de um questionário para avaliar as condições de uso e de gerenciamento dos EMAs, na perspectiva dos atores em saúde, e a implementação do modelo estrutural. Como síntese das evidências operacionais, o estudo de caso contribuiu na identificação de treinamentos periódicos aos atores em saúde e na necessidade de padronização das informações em nível assistencial. A utilização de modelos de probabilidade sob o enfoque paramétrico mostrou-se adequado para compreender o intervalo e a política de manutenção mais adequada ao comportamento das taxas de falha de cada equipamento, em que a distribuição Weibull comprovou ser adequada a diversas situações práticas. O modelo proposto caracteriza-se numa ferramenta prática e objetiva para apoiar a tomada de decisão dos gestores em saúde, fornecendo múltiplos indicadores de confiabilidade e de desempenho ao processo tecnológico que, em conjunto, contribuem para o aumento da confiabilidade, disponibilidade e redução de custos operacionais.<br> / Abstract : Actions and trends of Clinical Engineering (CE) are strongly influenced by the technological process in health. Through of health technology management the CE can contribute with methodologies for all phases of life cycle of the technologies. In order to meet changes in the lifecycle, it has been created a model for medical equipment management in the use phase. This proposal is based on a structural model to analyze the reliability of medical equipments. The model consists of three modules: data collection, statistical analysis and support in decision making. To test the application of the methodology, a case study was performed in seven establishment assistencial the health. This study was focused to the application of a survey to assess the management and use conditions of medical equipment from the point of view of healthcare professionals, and the implementation of structural model. As a synthesis of operational evidence, a case study contributed in identification of periodical training of healthcare professionals and the necessity of standardization on assistance level. The use of probability models under the parametric approach are capable to understand the interval and the most appropriate maintenance policy to behavior of failures rates of each medical equipment, where the Weibull distribution proved to be suitable for many practical situations. The proposed model is characterized in a practical and objective tool to support decision making of health managers by providing multiple indicators of reliability and performance of the technological processes, which contribute to increase reliability, availability, and reduce operating costs.