Esta pesquisa tem como enfoque central a especificidade do trabalho do cirurgiãodentista (CD), na atenção primária em saúde e, como objeto de estudo, a construção de suas competências gerais e específicas e sua contribuição para a construção do Sistema Único de Saúde (SUS). Os referenciais de competência e atenção primária em saúde, articulados aos princípios do SUS e da estratégia de Saúde da Família, fundamentaram teoricamente este trabalho. A definição dos municípios do estudo e da escolha dos sujeitos deu-se em função da utilização da técnica Delphi, como método de investigação. Foram selecionados 12 municípios da Região do Triângulo Mineiro/ Alto Paranaíba e a totalidade dos 509 cirurgiões-dentistas da rede básica do SUS. Participaram da pesquisa 11 municípios e 337 cirurgiões-dentistas. Os resultados em relação ao perfil dos CD apontaram que a maioria é de mulheres (69,5%); tem a idade de mais de 36 anos (70%); casados (65%); estão a longo período trabalhando na atenção básica de saúde (53% acima de 10 anos); e em busca da diferenciação neste contexto de mercado, a partir da realização da pósgraduação (especialização), sendo que 55,8% cursaram ou estão cursando a especialização e 3,6% são mestres. As 20 competências analisadas, dentre as gerais e as específicas, foram selecionadas pelo Painel Delphi, como apropriadas e relevantes para o cirurgiãodentista na atenção primária em saúde, obtendo níveis de concordância, parcial e total, acima de 83%. As mesmas agruparam-se com tendência de maior valorização nas categorias definidas como (a) competências técnicas e de serviço: conhecimento técnico-científico com intervenção clínica humanizada; diagnóstico preciso; coordenação e execução de ações coletivas de promoção e prevenção em saúde; promoção e educação em saúde; educação permanente; execução de visitas domiciliares qualificadas; atendimento adequado a grupos específicos; atenção odontológica com enfoque para gestantes e bebês; interação e conhecimento da comunidade que atua; trabalho em equipe multiprofissional e habilidade manual, em (b) competências pessoais e comunicativas: criatividade e capacidade de adaptação; criatividade com iniciativa e flexibilidade; liderança; segurança e confiança, em (c) competências do cuidado e organizacionais ou metódicas: acolhimento ao usuário e humanização; planejamento em saúde; gerenciamento e organização. Em contraponto, o menor percentual de concordância (83.1%) correspondeu a competência responsabilidade social, alocada neste estudo na (d) categoria sóciopolítica. As competências requeridas para o trabalho do cirurgião dentista na atenção primária em saúde fazem parte, indispensável, junto a um conjunto de demais ações estratégicas, que possibilitam o suporte necessário para a construção do SUS. Estas competências devem atender as necessidades de articulação da prática e da formação do CD, em uma perspectiva dos atributos essenciais da Atenção Primária em Saúde (APS) em interface com os princípios do SUS e da estratégia de Saúde da Família, com ênfase no cuidado à saúde e na responsabilidade social. / The main focus of this study is the specificity of dental surgeons work in primary health care, looking at the development of their general and specific competencies and their contribution to the construction of the Brazilian Single Health System (SUS). Competence and primary health care, articulated with the principles of the SUS and the Family Health strategy, served as the theoretical reference framework for this study. The definition of study cities and the choice of study subjects occurred in function of the use of the Delphi technique as the research method. Twelve cities were selected from the Triângulo Mineiro/Alto Paranaíba region, Brazil, and a total of 509 SUS dental surgeons (DS). Eleven cities and 337 dental surgeons participated in the study. Regarding the profile of the DS, the results indicated that most of them are women (69.5%); older than 36 (70%); married (65%); working in primary health care for a long time (53% more than 10 years) and seeking graduate programs (specialization) as a means to differentiate themselves in this labor market context, with 55.8% who attended or are attending specialization courses and 3.6% with a master s degree. Twenty specific and general competencies were analyzed, which were selected by the Delphi panel as appropriated and relevant for dental surgeons in primary health care, obtaining partial and total agreement levels above 83%. They were grouped according to their higher valuation tendencies in the categories defined as (a) technical and service competencies: technical-scientific knowledge with humanized clinical intervention; precise diagnostic; coordination and execution of collective health promotion and prevention actions; health promotion and education; permanent education; qualified home visits; adequate care to specific groups; dental care focusing on pregnant women and babies; knowledge and interaction with the community the professionals work in; multi-professional team work and manual ability; (b) personal and communicative competencies: creativity and adaptive capacity; creativity with initiative and flexibility; leadership; safety and trust; (c) care and organizational or methodical competencies: welcoming the user and humanization; health planning; management and organization. In counterpart, the lowest agreement percentage (83.1%) was found for the social responsibility competence, located in the (d) sociopolitical category. The competencies required of dental surgeons in primary health care are an indispensable part of a set of strategic actions, which provide the necessary support for the construction of the SUS. These competencies should meet the needs to articulate dental surgeons? practice and education, within the perspective of essential primary health care (PHC) attributes at the interface with SUS and the Family Health strategy principles, emphasizing health care and social responsibility.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2017-03-08T10:38:59Z No. of bitstreams: 2 Dissertação - Fabiano Calixto Fortes de Arruda - 2016.pdf: 1310988 bytes, checksum: 47a7fc51ab994e5a56cd5aec2e6f7310 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-03-08T11:28:50Z (GMT) No. of bitstreams: 2 Dissertação - Fabiano Calixto Fortes de Arruda - 2016.pdf: 1310988 bytes, checksum: 47a7fc51ab994e5a56cd5aec2e6f7310 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-03-08T11:28:50Z (GMT). No. of bitstreams: 2 Dissertação - Fabiano Calixto Fortes de Arruda - 2016.pdf: 1310988 bytes, checksum: 47a7fc51ab994e5a56cd5aec2e6f7310 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-12-09 / Quality of life (QoL) is the result of the individual's perception of their position in life, in the context of the culture and in the value system in which they live and their relationship with their goals, expectations, standards and concerns. It is a well-studied subject in the health area, and in 2015 alone we obtained about 25,000 publications on the subject according to PUBMED data. In its current concept it relates factors such as: health, social relations, psychological and environmental aspects of the individual with their environment and with other individuals. Plastic surgery is a medical surgical specialty that developed mainly during the great world wars, thanks to the development of anesthesia and antibiotic therapy. The surgeons in this area develop activity in the aesthetic and reconstructive area. The purpose of this dissertatio n is to describe the quality of life of the plastic surgeon in the State of Goiás. This study is about a dissertation constructed in the form of a scientific article. The first article is an integrative review of published studies on the quality of life of the physician in Brazil. Medical related studies are still scarce and do not present the same instrument in the evaluation of professionals, but indicate that the worst domains of the WHOQOL instruments are related to the environment, social and psychological relations. The second article describes the sociodemographic and professional profile of the plastic surgeon in the state of Goiás. It presents a young population, predominantly male, with a time of activity in the area of less than 10 years, with about 2 children, working more than 40 hours a week and performing Aesthetic and reconstructive surgeries. When compared in relation to the time of action, it is observed that they increase the monthly income, the number of surgeries and decrease the weekly workload. The third article reports the results found on the quality of life of the plastic surgeon in the state of Goiás relating to variables present in the sociodemographic and professional profile. The study showed that surgeons who have children, are married, have a monthly income of more than R $ 30,000.00 (about 34 minimum wages), do not perform shifts or are performed in the specialty, work up to 40 hours a week and have more That 4 surgeries per week, present domains with better quality of life. It is concluded that the quality of life of the Goias’ plastic surgeon is influenced by factors such as marital status,professional working time, condition of association with the SBCP, no work shifts in another specialty, weekly workload and number of surgeries performed per week. Older surgeons have better quality of life. Therefore, it is necessary to create mechanisms that can cooperate with the new specialist so that he can adapt to the market and enjoy a better quality of life. / Qualidade de vida (QV) é o resultado da percepção do indivíduo de sua posição na vida, no contexto da cultura e no sistema de valores nos quais vive e a relação destes com seus objetivos, expectativas, padrões e preocupações. É um tema bastante estudado nas áreas da saúde, daí só no ano de 2015 termos obtido cerca de 25.000 publicações sobre o tema segundo dados do PUBMED. Em seu conceito atual ela relaciona fatores como: a saúde, as relações sociais, aspectos psicológicos e ambientais do indivíduo com seu meio ambiente e com os outros indivíduos. A cirurgia plástica é uma especialidade médica cirúrgica que se desenvolveu principalmente durante as grandes guerras mundiais, graças ao desenvolvimento da anestesia e da antibioticoterapia. Os cirurgiões nesta área desenvolvem atividade na área estética e reconstrutiva. O objetivo desta dissertação é descrever a qualidade de vida do cirurgião plástico no Estado de Goiás. Este estudo trata se de uma dissertação construída na modalidade de artigo científico. O primeiro artigo é uma revisão integrativa sobre os estudos publicados sobre qualidade de vida do médico no Brasil. Os estudos relacionando médico ainda são escassos e não apresentam o mesmo instrumento na avaliação dos profissionais, porém indicam que os piores domínios dos instrumentos WHOQOL estão relacionados ao meio ambiente, relações sociais e psicológico. O segundo artigo descreve o perfil sóciodemográfico e profissional do cirurgião plástico no estado de Goiás. Apresenta uma população jovem, predominantemente masculina, com tempo de atividade na área inferior a 10 anos, com cerca de 2 filhos, trabalhando mais de 40 horas semanais e realizando cirurgias estéticas e reconstrutivas. Quando comparados em relação ao tempo de atuação é observado que estes aumentam o rendimento mensal, o número de cirurgias e diminuem a carga horária semanal. O terceiro artigo relata os resultados encontrados sobre a qualidade de vida do cirurgião plástico no estado de Goiás relacionando com variáveis presentes no perfil sóciodemográfico e profissional. O estudo mostrou que os cirurgiões que têm filhos, são casados, apresentam renda mensal superior a R$ 30.000,00 (cerca de 34 salários mínimos), não realizam plantões ou se realizam são na própria especialidade, trabalham até 40 horas semanais e têm mais que 4 cirurgias por semana, apresentam domínios com melhor qualidade de vida. Conclui-se que a qualidade de vida do cirurgião plástico do Estado de Goiás é influenciada por fatores como estado civil, tempo de atuação como profissional, condição de associação com a SBCP, não realizar plantões em outra especialidade, carga horária semanal e número de cirurgias realizadas por semana. Os cirurgiões mais antigos apresentam melhores condições de qualidade de vida. Portanto, é necessário a criação de mecanismos que possam cooperar com o especialista novo para que este possa se adaptar ao mercado e desfrutar de uma melhor qualidade de vida.

Made available in DSpace on 2016-08-19T17:47:05Z (GMT). No. of bitstreams: 1 DISSERTACAO_FRANCISCA MIRANDA DE ARAUJO.pdf: 2682041 bytes, checksum: 067d9adccb7aeaabfa7715e9afb036d0 (MD5) Previous issue date: 2014-10-26 / Ergonomics is a science that relates to the medical field, in order to humanize the work and improve their results, searching for that comfort and safety in the workplace, reducing the risks of accidents and illnesses relating to the function, thus increasing productivity. The surgeon is exposed to ergonomic constraints (physical, mental and emotional) that may affect your health, from aspects related to physical posture while working, to psychological problems, the management conditions in the operating room environments. This study sought to focus on the technical, environmental and organizational aspects of the surgeon's job as well as some factors in their condition in two public hospitals in São Luís / MA. The objective was to evaluate the working conditions for elective surgeries, propose measures to benefit the activity, and contribute to improving working conditions for these professionals. The survey results show dissatisfaction of professionals regarding ace physical / environmental and managerial issues involved directly in their working conditions. Also realize dissatisfaction with the presence of risk for discomfort / pain in all body segments surveyed. / A ergonomia é uma ciência que se relaciona com a área médica, visando humanizar o trabalho e melhorar seus resultados, buscando para isso o conforto e a segurança no posto de trabalho, diminuindo os riscos de acidentes e doenças relativas à função, consequentemente aumentando a produtividade. O médico cirurgião está exposto a constrangimentos ergonômicos (físicos, mentais e emocionais) que podem influir na sua saúde, desde aspectos relacionados à postura física durante o trabalho, até problemas psicológicos advindos das condições gerenciais nos ambientes dos centros cirúrgicos. Este estudo buscou focalizar os aspectos técnicos, ambientais e organizacionais do posto de trabalho do médico cirurgião assim como alguns fatores da sua condição física em dois hospitais da rede pública em São Luís/MA. O objetivo foi avaliar as condições de trabalho durante cirurgias eletivas, propor medidas para beneficiar a atividade, e contribuir para melhoria das condições de trabalho dos referidos profissionais. Os resultados da pesquisa mostram insatisfação dos profissionais em relação ás questões físico /ambientais e gerenciais envolvidas diretamente em suas condições de trabalho. Percebem também com insatisfação a presença de risco para desconforto/dor em todos os segmentos corporais pesquisados.

Na história recente, o exercício da profissão de Cirurgião-Dentista tem sido alvo de inúmeras ações judiciais das mais diversificadas, impetradas por pacientes descontentes com os resultados obtidos em seus tratamentos odontológicos. Considerando os direitos inerentes à pessoa do paciente e a enorme preocupação da classe odontológica com relação às demandas judiciais originadas pela falta de informação adequada a seus pacientes, alguns aspectos importantes do Consentimento Informado bem como da própria responsabilidade civil odontológica estão abordados neste estudo, a fim de esclarecer e evitar as constantes demandas judiciais contra dentistas por falta de um termo de Consentimento Informado. A informação, seja verbal ou escrita, sobre um diagnóstico, procedimento terapêutico, ou tratamento odontológico aos pacientes ou familiares, e a forma como explicar de maneira compreensiva o que está sendo repassado é um grande conflito entre a classe odontológica nos dias atuais. O Consentimento Informado e o Termo de Consentimento Livre e Esclarecido vem ser a forma, verbal e escrita de como o cirurgião-dentista informa o seu paciente ou representante, de modo límpido, os atos e etapas, relacionados ao diagnóstico e ao seu tratamento terapêutico, esclarecendo os riscos e benefícios, vantagens e desvantagens de forma que possa, autonomamente, escolher por realizar, ou não, o possível tratamento. O objetivo deste trabalho foi realizar o levantamento e análise das decisões recursais dos Tribunais de Justiça do sul do Brasil, utilizando a Internet. Dos 102 acórdãos avaliados 30 são do Tribunal de Justiça do Paraná, 17 do Tribunal de Justiça de Santa Catarina e 55 do Tribunal de Justiça do Rio Grande do Sul. Em relação ao Consentimento Informado, Termo de Consentimento Livre e Esclarecido ou mesmo a prova da Informação, constatou-se que nos referidos acórdãos estes assuntos foram pouco citados, porém observou-se que quando mencionados serviram de subsídios consistentes para defesa do profissional. / In recent history, the profession of dental surgeon has been the target of numerous lawsuits from more diverse, filed by patients dissatisfied with the results obtained in their dental treatment. Considering the inherent rights of the patient and the dental class of great concern with respect to lawsuits stem from the lack of adequate information to their patients, some important aspects of informed consent as well as from civil liability in dentistry are addressed in this study in order to clarify and avoid the constant lawsuits against dentists by a lack of informed consent The information, whether oral or written, about a diagnosis, therapeutic procedure, or dental treatment to patients or relatives, and how to comprehensively explain what is being passed is a major conflict between the dental class nowadays. Informed Consent and the Term of Consent has to be the case, verbal and written like the dentist tells the patient or his representative, so clear, the actions and steps, related to diagnosis and therapeutic treatment, accounting the risks and benefits, advantages and disadvantages so that you can, independently, choose to perform, or not, the possible treatment. The aim of this study was to survey and analysis of appellate decisions of the Courts of Justice in southern Brazil, using the Internet. Of the 102 judgments are assessed 30 of the Court of Paraná, 17 of the Court of St. Catherine and 55 of the Court of Rio Grande do Sul. Regarding Informed Consent, Termination of Consent or even proof of Information it was found that the judgments were seldom mentioned these issues, but noted that when mentioned served as subsidies for consistent defense of the professional.

Fel i operationssalen kan få stora konsekvenser. Enligt både WHO och Socialstyrelsen är kommunikation och koordination den främsta orsaken till vårdskador inom sjukvården. Operationsavdelningen är den plats inom sjukvården där flest vårdskador händer och de beror ofta på dåligt samarbete i operationslaget. Studier har visat att störst skillnad i uppfattning om effektivt samarbete finns hos operationssjuksköterskor och kirurger. Operationssjuksköterskor beskriver gott samarbete som när deras arbetsinsats respekteras medan ett gott samarbete för kirurger kännetecknas av att ha operationssjuksköterskor som förutser deras behov och följer instruktioner. Syftet med denna studie var att undersöka operationssjuksköterskors och kirurgers uppfattning om samarbete i operationslaget. Det är en deskriptiv kvantitativ studie baserad på datainsamlande genom frågeformulär. Urvalet bestod av 25 operationssjuksköterskor och 42 kirurger. Den mest påtagliga skillnaden i uppfattning om samarbete mellan operationssjuksköterskor och kirurger visade sig i frågan om det är läkaren som ansvarar för samordningen. De ansvariga måste bli medvetna om och komma till rätta med de skillnader i uppfattning om samarbete som finns mellan kirurger och operationssjuksköterskor för att WHO:s checklista och andra interventioner för ökad patientsäkerhet ska kunna få önskad effekt. / Errors in the operating room (OR) may have major consequences. According to the Swedish National Board of Health and Welfare and WHO, communication and coordination are the most common cause of harm to patients. Studies in the US have shown that the OR is the most common site in hospitals for adverse events to occur. Differences in perceptions of teamwork exist in the OR, with physicians rating the teamwork with others as good, and at the same time, nurses perceive teamwork as poor. Nurses often describe good collaboration as having their work respected, and physicians often describe god collaboration as having nurses who anticipate their needs and follow instructions. The aim of this study was to investigate Swedish nurses’ and physicians’ perception of teamwork. Operating room personnel, 25 nurses and 42 physicians where surveyed using a questionnaire. The most substantial difference where shown in the perception of who should be in charge of the team. To increase the likelihood of success when implementing the World Health Organization’s Surgical Safety Checklist, leaders should anticipate that differences in perception between members of different professions must be overcome if teamwork is to be improved.

Non-technical skills (NTS) are cognitive and interpersonal skills that are relevant to task completion such as situation awareness, decision-making, teamwork, and leadership. NTS in clinical environments, such as surgery, have been identified to contribute to patient safety and team performance, which in turn affects clinical outcomes. Assessment tools of these skills in surgery exist; however, current evaluations are limited in that they require trained raters, are subjective, are time-intensive, and are checklist-based. Therefore, there is a need for objective measurement of NTS that addresses the limitations of the rating-based techniques. The purpose of this Ph.D. dissertation work is to identify physiological and behavioral metrics that measure NTS objectively and investigate the application of objective metrics to measure intraoperative NTS of surgeons. Through a scoping review of engineering, behavioral science, and medical literature, behavioral and physiological metrics that quantified NTS constructs of surgeons were identified. The synthesized literature was used to build a framework integrating objective metrics to NTS constructs. To develop an objective model of surgeons’ NTS, subjective and objective behavioral data of surgeons were collected in the operating room and prediction models were created. Results found that objective metrics such as communication, speech, and proximity features can be used to predict subjective NTS. Furthermore, objective task features (e.g., time and number of incidents during an operation) has the potential to also model subjective NTS, and these task features can be predicted by the behavioral metrics; thus, triangulation is obtained with the three NTS metrics: subjective score, objective behavioral metrics, and task performance metrics. The relationship between the two objective metrics shows the possibility of achieving a fully objective model of surgeons’ NTS. The consolidation of current objective measurement techniques can provide a foundation in further understanding NTS beyond assessments based on observed behaviors, and the developed models can be expanded and implemented for real-time NTS assessment of clinical teams to improve patient care.

No description available.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20050号 / 医博第4158号 / 新制||医||1018(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 坂井 義治, 教授 松田 秀一, 教授 安達 泰治 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Additive Manufacturing (AM) is another name for rapid prototyping and 3D printing (3DP), an advanced manufacturing technology that creates 3D objects. AM's ability to produce complex shapes in industrial production is one of its chief advantages. AM is spreading to different areas in healthcare and is being considered a disruptive innovation that is changing orthopedics.  However, integrating AM into daily orthopedic practice remains a challenging task. This thesis aims to explore clinicians' views on the adoption of AM implants, surgical guides and accessories as well as investigating which way do regulations and policies affect the adoption of 3DP in the orthopedic industry in Sweden. Apart from reviewing existing literature contemplated on factors that affect the adoption of AM in an industry, in this study, a qualitative research approach have been used. A semi-structured interview has been applied to all the seven orthopedic surgeons who participated in the research. Using a thematic analysis approach, the data have been analyzed to address the thesis research questions.    According to the thesis findings, AM adoption in the orthopedic sector is influenced by a number of factors. With the technology, organization, and environment (TOE framework) there are classified into three main contexts. The study used the findings along with the TOE model, which embeds the regulation factor within an environmental context. The findings indicate that the medical device regulation (MDR) affects the adoption of medical devices both positively and negatively in the orthopedic industry in Sweden.  Technologically, the dilemma and challenge of adopting AM is influenced by the lack of resources in the healthcare field which also influence the organization context. It is the viewpoint of the buyer that orthopedists and hospitals have when it comes to adoption of AM. This means that the trading factor expressed in the environment context is another driving factor for AM adoption. By using the Kraljic model, AM technology has been classified as a strategic item. The procurement and purchase efforts should focus on establishing a long-term relationship with a single manufacturing company and both aiming to combine effort and resources to reduce total costs. In conclusion, The implementation of AM in orthopedic practice will be possible as long as all factors are taken into account. In orthopedic practice, AM should be used to create surgical guides, 3D models for surgical planning, and custom implants.

Additive Manufacturing (AM) is another name for rapid prototyping and 3D printing (3DP), an advanced manufacturing technology that creates 3D objects. AM's ability to produce complex shapes in industrial production is one of its chief advantages. AM is spreading to different areas in healthcare and is being considered a disruptive innovation that is changing orthopedics.  However, integrating AM into daily orthopedic practice remains a challenging task. This thesis aims to explore clinicians' views on the adoption of AM implants, surgical guides and accessories as well as investigating which way do regulations and policies affect the adoption of 3DP in the orthopedic industry in Sweden. Apart from reviewing existing literature contemplated on factors that affect the adoption of AM in an industry, in this study, a qualitative research approach have been used. A semi-structured interview has been applied to all the seven orthopedic surgeons who participated in the research. Using a thematic analysis approach, the data have been analyzed to address the thesis research questions.    According to the thesis findings, AM adoption in the orthopedic sector is influenced by a number of factors. With the technology, organization, and environment (TOE framework) there are classified into three main contexts. The study used the findings along with the TOE model, which embeds the regulation factor within an environmental context. The findings indicate that the medical device regulation (MDR) affects the adoption of medical devices both positively and negatively in the orthopedic industry in Sweden.  Technologically, the dilemma and challenge of adopting AM is influenced by the lack of resources in the healthcare field which also influence the organization context. It is the viewpoint of the buyer that orthopedists and hospitals have when it comes to adoption of AM. This means that the trading factor expressed in the environment context is another driving factor for AM adoption. By using the Kraljic model, AM technology has been classified as a strategic item. The procurement and purchase efforts should focus on establishing a long-term relationship with a single manufacturing company and both aiming to combine effort and resources to reduce total costs. In conclusion, The implementation of AM in orthopedic practice will be possible as long as all factors are taken into account. In orthopedic practice, AM should be used to create surgical guides, 3D models for surgical planning, and custom implants.