Política de humanização em serviços de saúde – contributos para a definição de indicadores

A reforma dos cuidados de saúde primários (CSP), iniciada em 2005, visa melhorar o desempenho dos centros de saúde através da reorganização dos serviços em várias unidades funcionais, no sentido de resolver os problemas tendo em conta as necessidades a satisfazer, complementando-se entre si e assumindo compromissos de acessibilidade e qualidade nos cuidados de saúde prestados. Ao mesmo tempo, são criados órgãos de gestão e governação clínica que nunca antes existiram nos CSP, envolvendo a participação da comunidade. A optimização da gestão e da governação clínica permitiu organizar os serviços de saúde em Agrupamentos de Centros de Saúde (AGES), dando-lhes poderes e responsabilidades para solucionarem problemas e tomarem as decisões acertadas e céleres, já que conhecem melhor as necessidades de saúde das populações. As relações burocráticas são substituídas por relações de contratualidade, orientadas para obter melhores resultados em saúde. Partindo destes pressupostos, o estudo realizado pretende analisar a percepção de profissionais de saúde quanto à política de humanização dos CSP, bem como, identificar/construir indicadores que avaliem essa política, sendo um estudo de carácter exploratório e descritivo, à luz de uma abordagem qualitativa. Participaram neste estudo cinco profissionais de saúde da Administração Regional de Saúde (ARS) do Norte, lP, do Departamento de Contratualização, Departamento de Estudos e Planeamento da ARS Norte e do AGES Tâmega 11 - Vale Sousa Sul, seleccionados por conveniência e inquiridos por entrevista semi-estruturada. Os dados foram tratados através da análise de conteúdo com o apoio informático NVivo9. Os resultados apresentados, com base nas entrevistas realizadas aos participantes no estudo, sustentam que os actuais indicadores quantitativos contratualizados com as unidades funcionais, expressam a política de humanização num serviço de saúde, não coincidindo totalmente com as definições internacionais expressas neste estudo.

Integrating the LMS in service oriented e-learning systems

Learning management systems are routinely used for presenting, solving and grading exercises with large classes. However, teachers are constrained to use questions with pre-defined answers, such as multiple-choice, to automatically correct the exercises of their students. Complex exercises cannot be evaluated automatically by the LMS and require the coordination of a set of heterogeneous systems. For instance, programming exercises require a specialized exercise resolution environment and automatic evaluation features, each provided by a different type of system. In this paper, the authors discuss an approach for the coordination of a network of eLearning systems supporting the resolution of exercises. The proposed approach is based on a pivot component embedded in the LMS and has two main roles: 1) provide an exercise resolution environment, and 2) coordinate communication between the LMS and other systems, exposing their functions as web services. The integration of the pivot component in the LMS relies on Learning Tools Interoperability (LTI). This paper presents an architecture to coordinate a network of eLearning systems and validate the proposed approach by creating such a network integrated with LMS from two different vendors.

Aplicação da técnica Análise do Valor (AV) a um determinado porduto/serviço

Mestrado em Engenharia Mecânica - Gestão de Processos e Operações

Insignificant impact of prescribed fire on surface soil in a Pinus pinaster plantation, northern Portugal

Following a prescribed fire in a Pinus pinaster forest site located in the north-west Portugal, monitoring of any changes in selected soil characteristics and soil hydrology was undertaken to assess the effects of burning on the following: pH, electrical conductivity, water content, organic carbon and porosity. Thirty plots were established on a regular grid. At each sample plot before and after the fire, samples were collected (disturbed samples from depths of 0-1cm and 1-5cm; undisturbed core samples from 0-5cm). The results indicate that there was no measurable impact on the properties of the soil following this carefully conducted prescribed fire. The fire only affected the litter layer, as intended. Confirmation of this minimal impact on the soil was provided by regrowth of grasses and herbs already occurring two months after the fire. The implication is, therefore, that provided this wildfire-risk reduction strategy is carried out under existing strict guidelines, any impact on soil quality will be minimal.

CrimsonHex: a service oriented repository of specialised learning objects

The corner stone of the interoperability of eLearning systems is the standard definition of learning objects. Nevertheless, for some domains this standard is insufficient to fully describe all the assets, especially when they are used as input for other eLearning services. On the other hand, a standard definition of learning objects in not enough to ensure interoperability among eLearning systems; they must also use a standard API to exchange learning objects. This paper presents the design and implementation of a service oriented repository of learning objects called crimsonHex. This repository is fully compliant with the existing interoperability standards and supports new definitions of learning objects for specialized domains. We illustrate this feature with the definition of programming problems as learning objects and its validation by the repository. This repository is also prepared to store usage data on learning objects to tailor the presentation order and adapt it to learner profiles.

A contribution to the e-framework: a specification of a programming exercise evaluation service

This work is a contribution to the e-Framework, arguably the most prominent e-learning framework today, and consists of the definition of a service for the automatic evaluation of programming exercises. This evaluation domain differs from trivial evaluations modelled by languages such as the IMS Question & Test Interoperability (QTI) specification. Complex evaluation domains justify the development of specialized evaluators that participate in several business processes. These business processes can combine other type of systems such as Programming Contest Management Systems, Learning Management Systems, Integrated Development Environments and Learning Object Repositories where programming exercises are stored as Learning Objects. This contribution describes the implementation approaches used, more precisely, behaviours & requests, use & interactions, applicable standards, interface definition and usage scenarios.

Specifying a programming exercises evaluation service on the e-Framework

The e-Framework is arguably the most prominent e-learning framework currently in use. For this reason it was selected as basis for modelling a programming exercises evaluation service. The purpose of this type of evaluator is to mark and grade exercises in computer programming courses and in programming contests. By exposing its functions as services a programming exercise evaluator is able to participate in business processes integrating different system types, such as Programming Contest Management Systems, Learning Management Systems, Integrated Development Environments and Learning Object Repositories. This paper formalizes the approaches to be used in the implementation of a programming exercise evaluator as a service on the e-Framework.

Using the learning tools interoperability framework for LMS integration in service oriented architectures

The LMS plays an indisputable role in the majority of the eLearning environments. This eLearning system type is often used for presenting, solving and grading simple exercises. However, exercises from complex domains, such as computer programming, require heterogeneous systems such as evaluation engines, learning objects repositories and exercise resolution environments. The coordination of networks of such disparate systems is rather complex. This work presents a standard approach for the coordination of a network of eLearning systems supporting the resolution of exercises. The proposed approach use a pivot component embedded in the LMS with two roles: provide an exercise resolution environment and coordinate the communication between the LMS and other systems exposing their functions as web services. The integration of the pivot component with the LMS relies on the Learning Tools Interoperability. The validation of this approach is made through the integration of the component with LMSs from two vendors.

Implementação e integração do modelo de acreditação da Joint Commission International na unidade de imagiologia do Hospital Privado da Boavista

Este trabalho descreve a abordagem abrangente sobre a melhoria do sistema de gestão da qualidade na Unidade de Imagiologia do Hospital da Boavista através da implementação das normas de acreditação da Joint Commission International (JCI). Fundamental para a melhoria geral da qualidade é a redução contínua de riscos para os doentes e para os profissionais da Unidade. Tais riscos podem existir ao nível do ambiente físico assim como no circuito dos exames e dos doentes. A acreditação em Saúde é uma das prioridades estratégicas do Ministério da Saúde e tem como objetivo fortalecer a confiança dos cidadãos nos profissionais de saúde bem como nas instituições de saúde. É importante que Portugal cultive a melhoria da qualidade e segurança nas instituições de saúde mantendo uma relação adequada custo/benefício. A União Europeia tem feito um esforço para que a acreditação seja harmoniosa nos seus princípios, no entanto é respeitada sempre a prevalência da legislação de cada país, bem como as suas especificações culturais e religiosas (Shaw, 2006), responsabilizando-o pelo seu sistema de saúde O trabalho aqui apresentado tem como objetivo principal fundamentar a escolha do modelo de acreditação da JCI para o Hospital da Boavista, nomeadamente para a Unidade de Imagiologia, ver se os padrões estão de acordo com os procedimentos da Unidade, identificar falhas e apontar possiveis melhorias. Pretende-se ainda mostrar a importância da implementação dos sistemas de certificação e acreditação da gestão da qualidade, documentada pela experiência profissional, bem como o know-how do Hospital da Boavista, assim como a complementaridade dos programas da gestão da qualidade, certificação e acreditação. A escolha do modelo de acreditação da JCI, foi uma opção do Hospital da Boavista baseada na credibilidade e no grau de exigência que a entidade impõe. Foi imperativo que a Unidade de Imagiologia realizasse as suas funções de forma válida e fiável e que disponibilizasse produtos / serviços de qualidade. A monitorização e consequente controlo de qualidade do serviço prestado pela Unidade de Imagiologia, foi difícil mas simplificado, em parte, devido ao sistema de gestão da qualidade ISO 9001:2008 já implementado, tendo este sido consolidado com a implementação da acreditação da JCI, com padrões específicos bem definidos na gestão do controlo de qualidade na Unidade de Imagiologia do Hospital da Boavista.

Study on the changes of soil chemical characteristics as result of prescribed fire

Every year, particularly during the summer period, the Portuguese forests are devastated by forest fire that destroys their ecosystems. So in order to prevent these forest fires, public and private authorities frequently use methods for the reduction of combustible mass as the prescribed fire and the mechanical vegetation pruning. All of these methods of prevention of forest fires alter the vegetation layer and/or soil [1-2]. This work aimed the study of the variation of some chemical characteristics of soil that suffered prescribed fire. The studied an area was located in the Serra of Cabreira (Figure 1) with 54.6 ha. Twenty sampling points were randomly selected and samples were collected with a shovel before, just after the prescribed fire, and 125 and 196 days after that event. The parameters that were studied were: pH, soil moisture, organic matter and iron, magnesium and potassium total concentration. All the analysis followed International Standard Methodologies. This work allowed to conclude that: a) after the prescribed fire; i) the pH remained practically equal to the the initial value; ii) occurred a slight increase of the average of the organic matter contents and iron total contents; b) at the end of the sampling period compared to the initial values; i) the pH didn´t change significantly; ii) the average of the contents of organic matter decreased; and iii) the average of the total contents of Fe, Mg and K increased.

A qualitative description of soil parameters variation due to a prescribed fire in Portuguese northwestern forests using Fuzzy Boolean Nets — The case study of Cabreira mountain

In this paper we study the modifications that occurred in some forest soil properties after a prescribed fire. The research focused on the alterations of soil pH, soil moisture and soil organic matter content during a two-year span, from 2008 to 2009. The study site is located in Anjos, Vieira do Minho municipality, a forest site that has suffered from recurrent wildfires for several decades. Furze (Ulex, sp.), broom (Cytisus, sp.), gorse (Chamaespartum tridentatum) and a very few disperse adult pine (Pinus sylvestris) are the predominant vegetation type in the study area. The average height of this shrub vegetation is around 1.5 m. The prescribed fire was conducted by the National Forestry Authority (AFN) in November 2008. Fuzzy Boolean Nets (FBN) were used to evaluate the alteration in soil parameters when compared with adjacent spots where: i) no fire occurrence was registered since 1998; ii) fire occurrence was registered in 2008; and iii) vegetation pruning by mechanical cut was done in Spring six months prior to the prescribed fire event. Results suggest that in the particular case of the studied site, Anjos, the observed soil properties alterations cannot be related with the prescribed fire.

Characterization of soils in an area of prescribed fire

The prescribed fire is a technique that is often used, it has several advantages. Pedological and hydropedological techniques were tested to assess the prescribed fire changes may cause in soils. This work was performed in Tresminas area (Vila Pouca de Aguiar, Northern Portugal), during February and March 2011. In the present study we applied several techniques. For the field sampling was followed the ISO 10381-1[1], ISO 10381-2[2], and FAO rules [3], as well as were used a grid with 17 points for measuring the soil parameters. During the fire, we have tried to check, with the assistance of the Portuguese Forestry Authority, some important parameters such as, the propagation speed, the size of the flame front and the intensity of energy emitted per unit area. Before the fire, was collected carefully soil disturbed and undisturbed samples for laboratory analysis, and measured soil water content; we also have placed four sets of thermocouples for measuring soil temperature. After the fire, were collected the thermocouples and new soil samples; the water content were measured in the soil and collected ashes. In the laboratory, after preparing and sieving the samples, were determined the soil particle size. The soil pH and electrical conductivity in water was also determined. The total carbon (TC) and inorganic carbon (IC)[4] was measured by a Shimadzu TOC-Vcsn. The water content in soil has not varied significantly before and after the fire, as well as soil pH and soil electrical conductivity. The TC and IC did not change, which was expected, since the fire not overcome the 200° C. Through the various parameters, we determined that the prescribed fire didn’t affect the soil. The low temperature of the fire and its rapid implementation that lead to the possible adverse effects caused by the wild fire didn’t occurred.

Effects of prescribed fire on surface soil in a Pinus pinaster plantation, northern Portugal

In order to decrease the risk of severe wildfire, prescribed fire has recently been adopted in Portugal and elsewhere in the Mediterranean as a major tool for reducing the fuel load instead of manual or mechanical removal of vegetation. There has been some research into its impact on soils in shrublands and grasslands, but to date little research has been conducted in forested areas in the region. As a result, the impact of prescribed fire on the physico-chemical soil characteristics of forest soils has been assumed to be minimal, but this has not been demonstrated. In this study, we present the results of a monitoring campaign of a detailed pre- and post-prescribed fire assessment of soil properties in a long-unburnt P. pinaster plantation, NW Portugal. The soil characteristics examined were pH, total porosity, bulk density, moisture content, organic matter content and litter/ash quantity. The results show that there was no significant impact on the measured soil properties, the only effect being confined to minor changes in the upper 1 cm of soil. We conclude that provided the fire is carried out according to strict guidelines in P. pinaster forest, a minimal impact on soil properties can be expected.

Fuzzy Boolean nets investigation of the alteration of some physical forest soil properties due to a prescribed fire action

Portuguese northern forests are often and severely affected by wildfires during the summer season. Some preventive actions, such as prescribed (or controlled) burnings and clear-cut logging, are often used as a measure to reduce the occurrences of wildfires. In the particular case of Serra da Cabreira forest, due to extremely difficulties in operational field work, the prescribed (or controlled) burning technique is the the most common preventive action used to reduce the existing fuel load amount. This paper focuses on a Fuzzy Boolean Nets analysis of the changes in some forest soil properties, namely pH, moisture and organic matter content, after a controlled fire, and on the difficulties found during the sampling process and how they were overcome. The monitoring process was conducted during a three-month period in Anjos, Vieira do Minho, Portugal, an area located in a contact zone between a two-mica coarse-grained porphyritic granite and a biotite with plagioclase granite. The sampling sites were located in a spot dominated by quartzphyllite with quartz veins whose bedrock is partially altered and covered by slightly thick humus, which maintains low undergrowth vegetation.