Els avenços que han experimentat tots els camps de la medicina en els darrers 20 anys han influït de forma notable en els tipus de malalts que són atesos als centres hospitalaris, sobre tot en hospitals de tercer nivell. L'aplicació de noves tecnologies o actituds terapèutiques corn el trasplantament de medúl.la òssia o d'òrgan sòlid i la utilització d'agents quimioteràpics han esdevingut cada cop més freqüents. A més a més, factors com la millora en l'atenció dels malalts ingressats en unitats de cures intensives, la nutrició parenteral, l'hemodiàlisi o els antibiòtics d'ampli espectre han contribuït de forma clara i favorable al tractament dels pacients en situacions crítiques. Això però, té una contrapartida negativa que es tradueix en la presència d'un major nombre de malalts hospitalitzats amb un compromís immunitari evident o amb patologies de base molt greus. Considerats corn un conjunt, aquests tipus de pacients constitueixen una població altament susceptible a patir una infeccin nosocomial que pot estar causada per diversos microorganismes entre els que cal incloure els fongs. Les infeccions fúngiques en aquests malalts són sovint severes, ràpidament progressives i generalment, hi ha certes dificultats per arribar al seu diagnòstic o realitzar un tractament adequat. L'increment experimentat en el nombre d'infeccions nosocomials fúngiques ha comportat, de forma paral.lela, un augment en el nombre de comunicacions científiques que descriuen diferents brots epidèmics nosocomia1s causats per fongs (Fridkin and Jarvis, 1996). És obvi que el focus d'origen o el mecanisme de transmissió pot ser molt diferent d'un brot a l'altre segons les característiques de l'agent implicat. A més a més, per determinar la causa d'un brot epidèmic concret i poder adoptar les mesures de control més adients per aturar-lo, és fonamental conèixer la fisiopatologia del fong implicat. Però, tal com ha passat amb les infeccions bacterianes, a mesura que aprofundim en l'epidemiologia d'una determinada infecció fúngica, i per extensió, la dels brots epidèmics, es fa cada cop més evident la necessitat d'utilitzar una determinada metodologia que ens ajudi a avaluar les troballes obtingudes. L'aplicació de mètodes moleculars per compendie millor l'epidemiologia de les infeccions fúngiques i la consegüent tipificació dels fongs implicats ha experimentat un impuls notable en els darrers 10 anys. Tot i els diversos mètodes existents, no hi ha però, un mètode considerat "standard" i l'elecció d'un o altre dependrà de les preguntes plantejades i les possibilitats de cada centre (Soll, 2000). Per tot allò comentat anteriorment, és obvi que la millora en el pronòstic de les infeccions fúngiques, sobre tot en malalts amb immunosupressió, és un objectiu que cal assolir el més aviat possible. Aquest objectiu es pot abordar des de diferents punts de vista. Així, en la pràctica diària hi ha dues opcions que semblen clares: avançar en les tècniques de diagnòstic precoç d'aquestes infeccions i la introducció en el tractament de nous antifúngics que millorin l'activitat, tolerància i seguretat dels antifúngics actuals. Hi ha però altres possibilitats que també cal estudiar per aconseguir l'objectiu que hem comentat. Algunes són necessàries com a pas previ a les opcions anteriors i altres simplement les complementen En aquesta tesi hem centrat el nostre treball en un aspecte més bàsic i inicial com és la valoració de l'activitat in vitro de nous antifúngics sobre fongs patògens prevalents amb la finalitat d'esbrinar les seves possibilitats com a fàrmacs potencialment útils en el tractament de les infeccions fúngiques. A més a més, hi ha un segon aspecte que també ha estat objecte d'anàlisi com és l'aplicació de la sonda semirepetitiva Ca3 a l'estudi de les infeccions nosocomials per “Candida albicans”.

Research Doctorate - Doctor of Philosophy (PhD) / In January 2005 Australia implemented the Australia-United States Free Trade Agreement (AUSFTA). The AUSFTA was a historic document because it laid out a closer trading association between Australia and its close ally, the United States (US). The Agreement was generally welcomed in both countries but it contained provisions that were controversial, perhaps none more so than those covering pharmaceuticals. In Australia there was deep concern over the effects of these provisions on the Pharmaceutical Benefits Scheme (PBS). A Senate Committee investigating the likely impact of the AUSFTA was apprehensive that the provisions would result in the PBS paying higher prices for some medicines. The many outcomes from the research reported in this thesis are preliminary but amongst them, three stood out. First, the AUSFTA instituted a number of small but significant changes to Australian pharmaceutical policies and processes. Some changes, around transparency and listing times, were positive while others, such as sponsor hearings before the PBAC, will probably have limited negative impact. Second, there is now a need to consider the AUSFTA commitments when Australian health policy is reassessed in the future, which will now make Australia’s regulatory processes more complex. Third, it is argued that the AUSFTA may have had input into major reforms of the Australian PBS. These reforms delivered on an outcome that had been sought by the US: a weakening of reference pricing as used by the Australian PBS. The benefit from the change to reference pricing for Australia is unclear, but the PBS is now more vulnerable to higher prices for new medicines in the future.

Australia�s policy on Quality Use of Medicines (QUM) aims to achieve appropriate use of medicines and improved health outcomes. Drug and Therapeutics Committees (DTCs) are educators, policy makers as well as financial gatekeepers in matters relating to medicine use. Increasingly, DTCs are also involved in risk management and clinical governance. As such, DTCs could be considered to be QUM advocates in the institutions in which they function. In a health care arena where there are escalating demands on high standards of clinical practice, quality assessment and improvement is essential in ensuring safe and effective patient care. Given the role DTCs play in safeguarding the interests of the stakeholders of the health care system, research into ways in which DTC performance could be enhanced is required. Although indicators specific to DTCs exist, the literature does not seem to provide straightforward answers to the question of what is currently being done in terms of quality assessment and quality improvement of DTCs. In the absence of such data, an opportunity for research is clearly identified. The first aim of this research project was to gain insight into the current activities undertaken by, and challenges facing Australian DTCs. Following this, the second aim was to explore ways in which DTC performance could be augmented. In addressing the first aim of this project, a national survey of Australian DTCs was conducted. These findings reinforce the evidence in the literature about the roles, structure and stakeholder expectations of DTCs. Our research also documents DTCs� quality improvement initiatives and barriers to DTC activities. It appears that there is little support available to Australian DTCs. Further, a case study was undertaken in order to gain an understanding of the depth and detail of DTC operations. An audit of a DTC in an Australian hospital was conducted. This study revealed that DTC decisions are being implemented in an ad hoc manner. In fact, there were no strategies (or action) planned to implement the majority of their decisions. This could have an impact on DTC performance. In view of this finding, qualitative methods were used to explore stakeholder opinions regarding the implementation of DTC decisions and policies. Stakeholders believed that strategies used to implement DTC policies should be targeted (to the audience as well as the type of decision/policy being implemented), timely, and delivered at the point of care. Face-to-face strategies were perceived to be more effective than printed materials, particularly when an influence on clinical practice was desired. Stakeholders also felt that the lack of resources was a significant barrier to DTC performance augmentation. This probably contributed to a lack of follow-up (or review) of implemented policies. According to stakeholders, other barriers to policy implementation include a lack of ownership of policies, low DTC profile, and an over-reliance on pharmacy to implement DTC decisions. Stakeholders felt one of the ways in which DTC performance could be improved was to prioritise DTC decisions for implementation. In pursuit of a method to prioritise DTC decisions, a survey was conducted. Stakeholders identified patient safety, cost, and the practice of evidence-based medicine as domains of important DTC decisions. The results also suggest that stakeholders recognise the need for the prioritisation of DTC decisions for implementation. Stakeholders implied that higher priority would be assigned to DTC decisions considered to be important. In a follow-up survey, stakeholders (including doctors, nurses, pharmacists, and DTC members) seemed to have agreement of the primary domains of DTC decisions. Higher levels of importance and higher priority were assigned to decisions involving the primary domains of patient safety and cost. However, level of importance and priority assignment were not consistently correlated. The work presented in this thesis suggests that there are ways to improve DTC performance. Although conducted primarily on hospital-based DTCs, it is anticipated that the lessons learnt could be applied to state-based, or even, Area Health-based DTCs. In conclusion, this research found that there was a range of views regarding �importance� and prioritisation for implementation. Social, organisational, as well as environmental factors may contribute to this. Future research should examine other possible factors contributing to the importance and priority of DTC decisions, so that DTC policy could be appropriately implemented into practice.

No description available.

Este trabalho teve como objetivos conhecer as demandas judiciais relacionadas à obtenção de medicamentos no município de Niterói no ano de 2010 e as estratégias desenvolvidas pela gestão municipal para lidar com este problema. Foi realizado estudo exploratório-descritivo, de abordagem quali-quantitativa, que seguiu dois caminhos metodológicos complementares: (1) levantamento e análise das demandas judiciais para obtenção de medicamentos registrados junto à Superintendência de Assessoria Jurídica da FMS, no período de janeiro a dezembro de 2010; e (2) entrevistas com 11 profissionais, gerentes e gestores envolvidos com os fluxos de atendimento das demandas judiciais no município em questão. Das 123 ações judiciais contra a FMS para obtenção de produtos e procedimentos em saúde em 2010, 98 (80,3%) visavam à obtenção de medicamentos, correspondendo a 342 medicamentos solicitados e 182 fármacos diferentes. destacaram-se, pela frequência nas ações, os seguintes medicamentos: losartana potássica, sinvastatina, ácido acetilsalicílico, furosemida e cloridrato de metformina, utilizados para problemas de saúde de elevada prevalência na população e frequentemente atendidos na atenção básica. Cabe ser assinalado que 48,6% dos medicamentos solicitados faziam parte de algum tipo de lista oficial, indicando possíveis problemas com a gestão da assistência farmacêutica no município. Os relatos dos entrevistados apontaram, entre outros: (a) dificuldades importantes presentes na gestão da Assistência Farmacêutica local, onde convivem o desabastecimento da rede e restrições orçamentárias e financeiras, como elementos que ajudam a agravar a situação estudada; (b) problemas no atendimento dos usuários pela via dos processos administrativos que, criados para facilitar o acesso do usuário aos medicamentos não disponíveis na rede, acabam sendo fontes de ações judiciais; (c) necessidade de maior empenho dos gestores na busca de soluções através de articulações interinstitucionais. O acesso a medicamentos pela via judicial tem contribuído para o desvio de recursos da atenção básica, assim como de outras contas municipais, através das multas e bloqueios determinados pelo Poder Judiciário, em decorrência do não-cumprimento dos mandados judiciais em tempo oportuno. O fenômeno da judicialização de medicamentos é um problema que dificilmente será resolvido em curto espaço de tempo e eventuais abusos que envolvem esse fenômeno devem ser identificados e combatidos de forma rigorosa. Entretanto, o Poder Público, por meio das diversas esferas governamentais, deve proporcionar à população meios eficazes para acesso aos medicamentos necessários e adequados aos pacientes. Apenas dessa maneira será possível reduzir a demanda judicial, sem comprometer o direito constitucional à saúde. / This study aimed to know the lawsuits related to obtaining medicines in the city of Niterói in 2010 and the strategies developed by the local administration to deal with this problem. An exploratory descriptive study, with qualitative and quantitative approach, was conducted and followed two complementary methodological approaches: (1) survey and analysis of lawsuits to obtain registered medicines at the Legal Advisory Board of Municipal Health Foundation from January to December 2010; and (2) interviews with 11 professionals and managers involved with the flow of litigation service in this municipality. Of the 123 lawsuits against the Municipal Health Foundation to obtain products and health procedures in 2010, 98 (80.3%) sought to obtain medicines, corresponding to 342 requested medicines and 182 different drugs. Considering the frequency of actions, the following medicines stood out: losartan-K, simvastatin, aspirin, furosemide and metformin hydrochloride, used for health problems of high prevalence in the population and often seen in primary care. It should be noted that 48,6% of medicines requested were part of some kind of official list, indicating possible problems with the management of pharmaceutical services in the municipality. The reports of the respondents pointed out, among other things: (a) major difficulties in managing the local Pharmaceutical Care, where the shortage of the network and financial and budgetary constraints coexist, as elements that help to aggravate the situation studied; (b) problems in service to users by means of administrative procedures that, designed to facilitate user access to medicines not available in the network, originate lawsuits; (c) need for greater involvement of managers in finding solutions through joint institutions. Access to medicines through the courts has contributed to the diversion of resources in primary care, as well as other municipal accounts, through fines and blocks determined by the Judiciary as a result of on-compliance with court orders in a timely manner. The phenomenon of judicialization of medicines is a problem that can hardly be solved in a short time and possible abuses involving this phenomenon should be identified and addressed rigorously. However, the Government, through the various levels of government, must provide the population with effective means of access to necessary and appropriate medicines to patients. Only this way lawsuits can be reduced, without jeopardizing the constitutional right to health.

Submitted by Helmut Patrocinio (hell.kenn@gmail.com) on 2017-11-24T01:32:25Z No. of bitstreams: 1 Cl?udio_Queiroz_Disserta??o.pdf: 793741 bytes, checksum: f79a2a4bb52a8be9ba0b57baec9ed09c (MD5) / Approved for entry into archive by Ismael Pereira (ismael@neuro.ufrn.br) on 2017-11-27T16:10:35Z (GMT) No. of bitstreams: 1 Cl?udio_Queiroz_Disserta??o.pdf: 793741 bytes, checksum: f79a2a4bb52a8be9ba0b57baec9ed09c (MD5) / Made available in DSpace on 2017-11-27T16:11:41Z (GMT). No. of bitstreams: 1 Cl?udio_Queiroz_Disserta??o.pdf: 793741 bytes, checksum: f79a2a4bb52a8be9ba0b57baec9ed09c (MD5) Previous issue date: 1999 / Nos ?ltimos dois s?culos, o conhecimento sobre o sistema nervoso central expandiu-se consideravelmente, possibilitando atualmente o tratamento de muitas patologias do sistema nervoso central. Uma dessas patologias, entretanto, a discinesia tardia n?o apresenta nenhum tratamento terap?utico de efic?cia comprovada (Soares, 1997). A discinesia tardia ? uma s?ndrome caracterizada por movimentos involunt?rios repetitivos, normalmente envolvendo a l?ngua, boca e face, ocasionalmente atingindo tamb?m o pesco?o, membros superiores e quadris. Acredita-se ser a discinesia tardia um efeito colateral da exposi??o prolongada aos antipsic?ticos (neurol?pticos). Essa disfun??o motora pode persistir por meses ou anos ap?s a retirada do tratamento com neurol?ptico, podendo at? mesmo ser irrevers?vel (Karniol, 1979; Casey, 1985; Kane, 1995). Nesta tese de Mestrado, procuramos estudar os efeitos comportamentais da administra??o de buspirona sobre modelos animais de discinesia tardia. Os modelos animais utilizados foram: [1] a supersensibilidade dopamin?rgica induzida por um tratamento prolongado com haloperidol e quantificada pela atividade espont?nea de ratos em um campo aberto e [2] pelo comportamento estereotipado induzido pela apomorfina e [3] a quantifica??o dos movimentos orofaciais de ratos ap?s um tratamento repetido com reserpina. O tratamento prolongado com buspirona per se (3.0 mg/kg, i.p., duas vezes ao dia, por 30 dias) n?o resultou em uma supersensibilidade comportamental em nenhum dos dois modelos animais. O tratamento concomitante de buspirona foi capaz de diminuir os sintomas da supersensibilidade dopamin?rgica induzida pelo haloperidol (2.0 mg/kg, i.p., uma vez ao dia, por 30 dias) e quantificada pela atividade geral em campo aberto, mas n?o pelo comportamento estereotipado induzido pela apomorfina. Nos experimentos agudos, apesar de a buspirona per se diminuir tanto a atividade gera em campo aberto como o comportamento estereotipado induzido pela apomorfina, a co-administra??o de buspirona n?o foi capaz de modificar o efeitos agudos do haloperidol sobre esses dois modelos animais. No terceiro modelo, ratos foram tratados com salina ou buspirona (3.0 mg/kg, i.p., duas vezes ao dia) e ve?culo ou reserpina (0.1 mg/kg, s.c., dias intercalados) por 19 dias. No vig?simo dia, os animais foram observados para a quantifica??o de seus movimentos orofaciais: freq??ncia de protrus?o de l?ngua e movimentos mandibulares e dura??o do tremor facial. O tratamento com buspirona per se n?o foi capaz de induzir a movimentos orofaciais. Animais tratados com reserpina apresentaram maior freq??ncia de movimentos orofaciais em rela??o aos animais tratados com salina. A co-administra??o de buspirona foi capaz de atenuar o desenvolvimento da discinesia orofacial induzida pela reserpina. Verificou-se, tamb?m, que os animais tratados cronicamente com buspirona (3.0 mg/kg, i.p., duas vezes ao dia, 30 dias) desenvolvem maior resposta ao comportamento de bocejo induzido pela apomorfina. Assim, com este trabalho observamos que o tratamento prolongado com buspirona foi capaz de atenuar comportamentos dependentes da disponibilidade de dopamina end?gena (atividade geral em campo aberto e movimentos orofaciais induzidos pela reserpina) provavelmente por meio de uma supersensibilidade dos receptores pr?-sin?pticos (sugerida pelo aumento do comportamento de bocejo induzido por apomorfina). Os dados aqui apresentados, juntamente com a literatura cl?nica existente at? o momento, sugerem um poss?vel papel terap?utico da buspirona no tratamento da discinesia tardia. / In the last two centuries, the knowledgement about the central nervous systems increased enormously, making possible the treatment of patients who suffer of all sort of central nervous systems? diseases. One of this diseases is Tardive Dyskinesia, a syndrome characterized by repetitive involuntary movements, usually involving mouth, face and tongue and sometimes limb and trunk musculature. The syndrome is considered to be an adverse effect of prolonged administration of antipsychotic drugs (normally named neuroleptics). It persists for moths after neuroleptic has been discontinued and may be irreversible (Karniol, 1979; Casey, 1985; Kane, 1995). In a recent meta-analysis study, Soares (1997) concluded that there is no efficacious therapeutic interventions for tardive dyskinesia. In this thesis, we studied the behavior effects of buspirone administration on animal models of tardive dyskinesia. These models comprised the [1] dopaminergic supersensitivity induced by long-term haloperidol administration, which is quantified by the spontaneous activity (locomotion and rearing frequency) of rats observed in an open-field or [2] by the apomorphine-induced stereotyped behavior, and [3] the quantification of orofacial dyskinesia in rats repeatedly treated with reserpine. In the first an second models, buspirone per se (3.0 mg/kg, i.p., twice daily, for 30 days) did not produce dopaminergic supersensitivity. When buspirone was given in combination to haloperidol (2.0 mg/kg, i.p., once daily, for 30 days), it decreased the neuroleptic withdrawal symptoms as detected in open-field but not in apomorphine-induced stereotypy. Although single administration of buspirone per se decreased both open-field and apomorphine-induced stereotypy behavior, buspirone single administration did not modify the acute effects of haloperidol on these two behavioral models. In the third model, rats were co-treated with saline or buspirone (3.0 mg/kg, i.p., twice daily) and vehicle or reserpine (0.1 mg/kg, s.c., once every other day) for 19 days. On the day 20, the animals were observed for the quantification of the behavioral parameters of orofacial dyskinesia: tongue protrusion and vacuous chewing movements frequencies and duration of twitching of the facial musculature. Reserpine-treated rats exhibited a significant increase in the three behavioral parameters of orofacial dyskinesia relative to the saline-treated rats. The co-administration of buspirone in the reserpine-treated rats attenuated the development of orofacial dyskinesia, when compared to the reserpine-treated rats. We also verified that chronic (30 days) buspirone treatment was able to increase apomorphine-induced yawning behavior. The possibility is raised that buspirone attenuates haloperidol-induced increased locomotion and rearing and reserpine-induced orofacial dyskinesia through the development of dopamine autoreceptor supersensitivity. Taken together with previous clinical reports, the present data suggest that buspirone co-administration may lead to important clinical effects concerning different tardive dyskinesia treatment.

Cette étude porte sur le mouvement non conventionnel en oncologie et tend à évaluer l’impact des MCA conjointement en termes de bénéfices, de risques et de dérives chez les patients atteints de cancer. Notre démarche comparative explore le vécu de 32 patients utilisant ou non les MCA, de façon complémentaire ou alternative aux traitements curatifs. Un entretien semi-directif unique a été mené auprès de chaque patient dans l’objectif d’identifier les processus communs et distincts entre les différents groupes. Un livret de questionnaire leur a également été remis afin de rendre compte des caractéristiques du mouvement hétérodoxe. L’analyse du discours révèle que le recours aux MCA influence positivement le vécu de la maladie sur l’ensemble des dimensions de la personne, mais détériore la représentation de la médecine allopathique et la relation soignant/soigné. Le refus de traitements curatifs chez les utilisateurs de MCA est lié à un univers de croyances invalidantes qu’ils développent. L’analyse des échelles suggère que le recours aux MCA améliore la perception de la santé globale, réduit la symptomatologie dépressive, mais reste sans effet sur l’anxiété. Le recours alternatif aux MCA est lié aux croyances d’attribution causale interne et de contrôle religieux, mais pas à celle d’un contrôle sur l’évolution de la maladie. L’intégration des MCA en oncologie apparaît pertinente et nécessaire pour améliorer la prise en charge des malades, mais doit pouvoir se déployer avec prudence et de façon progressive au regard des risques et des dérives de certaines pratiques hétérodoxes. / This study examines the unconventional movement in Oncology and aim to assess the impact of CAM jointly in terms of benefits, of risks and derivatives in patients with cancer.Our comparative approach explores the experience of 32 patients using or not the CAM of complementary or alternative to curative treatments. A unique semi directive interview was conducted with each patient in order to identify common and distinct processes between differents groups. A questionnaire booklet was also been handed them to end to account characteristics of the unconventional movement.Analysis of the speech shows that the use of CAM affects positively the experience of the illness across the dimensions of the person, but deteriorates the representation of allopathic medicine and the patient-caregiver relationship. The refusal of curative treatments among users of CAM is linked to a universe of disabling beliefs they develop.The analysis of scales suggests that the use of CAM improves the perception of global health, reduces the depressive symptomatology, but has no effect on anxiety. The alternative use of CAM is related to internal causal attribution and control beliefs, but not to control over the course of the disease. The integration of CAM in oncology appears relevant and necessary to improve the care of patients, but should be able to be deployed with caution and progressively in the light of the risks and derivatives of certain heterodox practices.

The overall objective of this study is to promote the human rights to health of Nigerian women to have access essential medicines, to enhance their human capabilities for human development. This thesis argues for an improvement of women’s access to medicines within the context of patent law and rights in the international IP regime of the Trade Related Aspect of Intellectual Property (TRIPS) Agreement and Nigeria’s national patent system. Towards this goal, the thesis makes the point that patent law and its exclusive rights, both the TRIPS Agreement and national law of Nigeria, do not exist in a social welfare vacuum. The legal text of patent law, which confers rights on inventors when enforced, translates to many other things outside the sphere of property rights; indeed, it can be a matter of life and death. It is argued in this regard that patent right could, in effect, interfere with access to medicines and therefore, the right to health and prospects for human development. The thesis therefore argues that, in the construction, interpretation and enforcement of patent law in Nigeria, there is a need to take into consideration its impact on public health. It is against this backdrop that the research assesses the legal framework of pharmaceutical patents and the implications for women’s access to medicines, from a right to health and human development perspective. This interdisciplinary study is with a view to suggesting ways in which Nigeria’s patent system can be more human development and human rights friendly in the interest of public health, particularly, the use of the TRIPS flexibilities to enhance access to life-saving medicines in Nigeria. Since Nigeria as a member of the World Trade Organisation, is bound by its treaty obligation to adopt the provisions of the TRIPS Agreement, the thesis makes proposals for ways in which the Nigerian government and law-makers, can adapt the patent rules and the flexibilities to suit development objectives and promote public health within the benchmark allowed in TRIPS. In this respect, this thesis critically investigates the practical implications of the available flexibilities and options in the TRIPS Agreement that can be used to address the effects of patents on access to medicines. While this thesis concedes the view that the hindrances to accessibility of essential drugs in Nigeria are multi-faceted and demand a multi-dimensional approach for a lasting solution, it is specifically argued that the TRIPS flexibilities are significant means for addressing the challenges of affordable access to important health treatments within the context of patent law. However, it is emphasised that utilising the flexibilities will require that Nigeria’s patent system is strategically designed to take full advantage of the available safeguards and options. To this end, this study recommends ways to incorporate the flexibilities to enhance access to medicines in Nigeria while avoiding the technical and regulatory pitfalls that have trailed the enforcement of the flexibilities by other developing countries.

Magister Pharmaceuticae - MPharm / Efforts to improve the quality of service delivery are an ongoing feature in different organisations. In the private health care sector, particularly pharmaceutical services in private hospitals, such efforts are important because of the sector’s commercial nature. This stems from the fact that customers pay a lot of money for services and expect services that are worth the money they pay. A private health care delivery group encourages such efforts in pharmacies of its hospitals through scientific research.Service providers and consumers were engaged to gain an appreciation of quality service delivery. The qualitative research method was used for the reason that it is scientific research that seeks to provide understanding and insight into social experiences as appreciated by the people involved and that it is a process of disciplined investigation that is methodical and verifiable.The research project was conducted to identify factors that influence pharmaceutical service delivery, to establish the understanding of quality pharmaceutical service delivery and establish the expectations of customers regarding pharmaceutical service rendered in a private hospital group.

The quantification of active principles is an indispensable stage of medicines quality control. For that reason a number of methodologies intended for pharmaceutical applications is constantly growing up. Thus, in view of great analysis demands, the development of low-cost, fast and automatized procedures is very useful. In this way, the present work proposes an analytical procedure for determination of paracetamol in pharmaceutical formulations employing Flow Injection Analysis (FIA) coupled to spectrophotometric detection. Interests for paracetamol is due to its large use as analgesic/antipyretic in Brazil. The proposed procedure is based on diazo-coupling reaction between sulfanilic acid and paracetamol in alkaline medium which forms an orange-reddish diazocompound that absorbs intensively at 500 nm. Optimization studies were carried out with experimental parameters and plotting a reference curve for determination of paracetamol. The linear work range including concentrations between 4.00 and 16.00 mg L-1 of paracetamol, with a correlation coefficient of 0.9991. The limit of detection for the considered work range shown be equal to 0.30 mg L- 1. The relative standard deviation to 10 replicates of the standard solution containing 8.00 mg L-1 of paracetamol was 1.28 %. The real sample analysis by the proposed procedure and by the official method demonstrated comparables results. The nominal amounts of paracetamol declared by the fabricants on the label of all analyzed pharmaceuticals formulations showed good agreement with the official specifications. Recovery studies in real samples revealed a mean rate of 97.1 % of the paracetamol standard added, assuring in such way the confidence of the proposed procedure. Studies realized in this work makes evident the viability of the use of the proposed procedure for determination of paracetamol, since this method has adopted an simple mechanized system, practice and produce results that do not differ significatively from the official method. Other advantages related at this procedure are the use of low toxic reagents and of low cost, good precision (repeatability) and reproducibility, generation of cromogenic product highly stable and suitable sensibility for quality control purposes. / Conselho Nacional de Desenvolvimento Científico e Tecnológico / A quantificação de princípios ativos é uma etapa indispensável do controle de qualidade de medicamentos, e em virtude disto, o número de metodologias desenvolvidas destinadas às aplicações farmacêuticas vem crescendo constantemente, visto que, diante de grandes demandas de análises, o desenvolvimento de procedimentos rápidos, pouco dispendiosos e automatizados é de grande valia. Desta forma, o presente trabalho propõe o desenvolvimento de procedimento analítico para determinação de paracetamol em formulações farmacêuticas empregando Análise por Injeção em Fluxo (FIA) associada à detecção espectrofotométrica. O interesse por este analito reside no fato deste fármaco ser um dos analgésicos/antipiréticos mais utilizados no Brasil. O procedimento proposto baseia-se na reação de diazoacoplamento entre ácido sulfanílico e paracetamol em meio alcalino com formação de um diazocomposto laranja-avermelhado que absorve intensamente em 500 nm. Foram realizados estudos de otimização dos parâmetros experimentais e construída uma curva de referência para determinação de paracetamol. A faixa linear de trabalho compreendem concentrações entre 4,00 e 16,00 mg L-1 de paracetamol, com um coeficiente de correlação de 0,9991. O limite de detecção para a faixa de trabalho considerada mostrou-se igual a 0,30 mg L-1. O desvio padrão relativo para 10 replicatas da solução padrão contendo 8,00 mg L-1 de paracetamol foi 1,28 %. As análises das amostras reais pelo procedimento proposto e pelo método oficial demonstraram resultados comparáveis. Os teores nominais de paracetamol declarados pelos fabricantes nos rótulos de todas as formulações farmacêuticas analisadas mostraram conformidades com as especificações oficiais. Estudos de recuperação em amostras reais revelaram uma taxa média de 97,1 % do padrão de paracetamol adicionado, garantindo desta forma a confiabilidade do procedimento proposto. Os resultados alcançados neste trabalho evidenciaram a viabilidade do emprego do procedimento proposto para a determinação de paracetamol, uma vez que este método adotou um sistema mecanizado simples, prático e quando aplicado para a quantificação de paracetamol em amostras comerciais produziu resultados que não diferiram significativamente do método oficial. Outras vantagens relacionadas a este procedimento são o uso de reagentes pouco tóxicos e de baixo custo, boa precisão (repetibilidade) e reprodutibilidade, geração de produto cromogênico altamente estável e com sensibilidade adequada para propósitos de controle de qualidade.