Barreiras e facilitadores à prática do acompanhamento farmacoterapêutico nos serviços farmacêuticos hospitalares portugueses

Objectivos: Identificar e compreender as barreiras e os facilitadores à prática do Acompanhamento Farmacoterapêutico (AFT) nos serviços farmacêuticos hospitalares portugueses. Método: Estudo qualitativo mediante realização de entrevistas semi-estruturadas a farmacêuticos hospitalares com e sem experiência no AFT e análise de conteúdo, retroactiva e temática. Resultados: Estrutura dos serviços farmacêuticos: barreiras (1) falta de tempo, organização das actividades orientadas para a logística, instabilidade dos recursos humanos, barreiras físicas à comunicação, relações em divergência; facilitadores (2) reestruturação, trabalho em equipa. Farmacêutico: (1) resistência à mudança, qualificação inadequada; (2) atitude positiva, legitimação, formação. Meio externo: (1) falta de apoio institucional, relacionamento com o doente, o médico e farmacêutico comunitário, ensino inadequado; (2) apoio institucional, procura do doente, cooperação com o médico e o farmacêutico comunitário, ensino adequado. Tecnologia: (1) acesso aos dados clínicos e a informação, método inadequado; (2) acesso à informação, método adequado, documentação, informatização, marketing, boas práticas. Conclusão: As entrevistas semi-estruturadas fornecerem uma visão ampla, detalhada e pragmática dos potenciais determinantes de uma prática generalizada do AFT nos serviços farmacêuticos hospitalares portugueses. /ABSTRACT: Objectives: To identify and understand the barriers and facilitators for the practice of Medication Therapy Management (MTM) in portuguese’s hospital pharmacy. Method: Qualitative study trough semi-structured interviews with MTM experienced and inexperienced hospital pharmacists followed by retroactive content and thematic analysis. Results: Structure of hospital pharmacy: barriers (1) lack of time, activities focused on logistics, instability of human resources, physical barriers to communication, divergent relationships; facilitators (2) restructuring, teamwork. Pharmacist: (1) resistance to change, inadequate skills, (2) positive attitude, legitimating, formation. Environment: (1) lack of institutional support, relationship with patient, physician and community pharmacist, inadequate teaching, (2) institutional support, patient's demand, cooperation with physician and community pharmacist, appropriate teaching. Technology: (1) lack of access to clinical data and information, inadequate method, (2) access to information, appropriate method, documentation, computerization, marketing, good pharmacy practices. Conclusion: The semi-structured interviews provide a broad, comprehensive and pragmatic view of potential determinants for wide practice of MTM in Portuguese’s hospital pharmacy.

Quando a morte antecede o nascimento: atuação do enfermeiro especialista em saúde materna e obstetrícia na assistência à mulher que vivência uma morte fetal

A perda gestacional é uma experiência dolorosa e complexa para a mãe/casal. O enfermeiro surge como promotor da adaptação á perda. Com esta intervenção, pretendo assegurar boas práticas de enfermagem na assistência às mulheres/casais em situação de perda gestacional. Foi realizado um estudo qualitativo em que se realizaram entrevistas a mulheres que vivenciaram perda gestacional e aos Enfermeiros Especialistas de Saúde Materna e Obstétrica como prestadores de cuidados. Os resultados mostram que os enfermeiros consideram a perda gestacional uma experiência difícil de vivenciar, identificando necessidades de formação. As mulheres referem diferenças na abordagem por parte dos enfermeiros aquando dos cuidados recebidos, falta de apoio e necessidade de encaminhamento após a alta hospitalar. Efetuou-se formação aos enfermeiros com peritos da área e desenvolveram-se procedimentos para uniformizar os cuidados. Foi criado um procedimento para uniformizar a prática e materiais de suporte para o apoio na prestação de cuidados de enfermagem; WHEN THE DEATH ANTECIPATES THE BIRTH: MIDWIVES' ROLE IN ASSISTANCE TO WOMENWHO EXPERIENCE FETAL DEATH. ABSTRACT: Pregnancy loss is a painful and complex experience to the mother/couple. The nurse is the promoting agent to the loss adaptation. With this project, I intend to ensure good nursing practices in assisting women/couples who experience a pregnancy loss. A qualitative study was performed, in which interviews were conducted to women who experienced a pregnancy loss and to nurse-midwives who provided care. Results demonstrated that nurse-midwives find pregnancy loss as a difficult experience, identifying educational needs. Women relate differences in the nurse-midwives’ approach during care, lack of support and the need of follow-up after hospital discharge. Nurse-midwives were subjected to training with experts and procedures were developed in order to standardize care. A practice standardizing procedure and educational materials were created to support nursing practice.

Evaluation of DUALEM, OptRx and Grassmaster II sensors for monitoring the spatial variability and the temporal stability of a Mediterranean pasture

Site-specific management (SSM) is a form of precision agriculture whereby decisions on resource application and agronomic practices are improved to better match soil and crop requirements as they vary in the field. SSM enables the identification of regions (homogeneous management zones) within the area delimited by field boundaries. These subfield regions constitute areas that have similar permanent characteristics. Traditional soil and pasture sampling and the necessary laboratory analysis are time-consuming, labour-intensive and cost prohibitive, not viable from a SSM perspective because it needs a large number of soil and pasture samples in order to achieve a good representation of soil properties, nutrient levels and pasture quality and productivity. The main objective of this work was to evaluate technologies which have potential for monitoring aspects related to spatial and temporal variability of soil nutrients and pasture green and dry matter yield (respectively, GM and DM, in kg/ha) and support to decision making for the farmer. Three types of sensors were evaluated in a 7ha pasture experimental field: an electromagnetic induction sensor (“DUALEM 1S”, which measures the soil apparent electrical conductivity, ECa), an active optical sensor ("OptRx®", which measures the NDVI, “Normalized Difference Vegetation Index”) and a capacitance probe ("GrassMaster II" which estimates plant mass). The results indicate the possibility of using a soil electrical conductivity probe as, probably, the best tool for monitoring not only some of the characteristics of the soil, but also those of the pasture, which could represent an important help in simplifying the process of sampling and support SSM decision making, in precision agriculture projects. On the other hand, the significant and very strong correlations obtained between capacitance and NDVI and between any of these parameters and the pasture productivity shows the potential of these tools for monitoring the evolution of spatial and temporal patterns of the vegetative growth of biodiverse pasture, for identifying different plant species and variability in pasture yield in Alentejo dry-land farming systems. These results are relevant for the selection of an adequate sensing system for a particular application and open new perspectives for other works that would allow the testing, calibration and validation of the sensors in a wider range of pasture production conditions, namely the extraordinary diversity of botanical species that are characteristic of the Mediterranean region at the different periods of the year.

Exploration of polymetallic nodules in the Area: Reporting practices, data management and transparency

The International Seabed Authority (ISA) regulates the activities related with the exploration and exploitation of seabed mineral resources in the Area, which are considered as the "common heritage of mankind" under the United Nations Convention on the Law of the Sea.The ISA has also the mandate to ensure the protection of the marine environment.The development of good practices for the annual reporting and data submission by Contractors is crucial for the ISA to comply with the sustainable development of the mineral marine resources. In 2015,the ISA issued a new template for reporting on exploration activities, which includes the definition of the format for all geophysical, geological and environmental data to be collected and analysed during exploration. The availability of reliable data contributes to improve the assessment of the ISA on the activities in the Area while promoting transparency, which is considered as a major principle of industry bestpractices.