Indicadores de qualidade para a contratualização de cuidados paliativos

RESUMO - Âmbito e objectivos: O presente trabalho incide sobre a área dos cuidados paliativos, nomeadamente, visa contribuir para uma maior efectividade do processo de aquisição e acompanhamento deste tipo de cuidados. Neste contexto, e como objectivo principal do estudo, foram identificados os indicadores chave, na vertente da qualidade, indispensáveis para a conceptualização de um modelo de contratualização e, consequentemente, para assegurar a monitorização, acompanhamento e avaliação da actividade realizada. Método e metodologias: Numa primeira fase, foi conduzida uma pesquisa documental tendente ao levantamento dos indicadores, na dimensão da qualidade, em utilização nos cuidados paliativos em vários países, tendo sido escolhidos aqueles que apresentavam indicadores já validados, designadamente, o Canadá, Reino Unido, Austrália, Espanha e EUA. Desta forma, foram seleccionados os indicadores comuns aos vários países estudados, para efeitos de discussão e consensualização, no âmbito de uma Técnica de Grupo Nominal, passíveis de integrarem um modelo de contratualização nesta área em Portugal. Apresentação e discussão de resultados: Da pesquisa documental resultaram 188 indicadores na dimensão qualidade, em utilização nos países estudados, tendo sido identificados 19 indicadores comuns. Estes indicadores foram submetidos a discussão e consensualização em reunião de peritos, tendo sido hierarquizados os sete indicadores mais adequados para a contratualização em cuidados paliativos: composição de uma equipa interdisciplinar; capacidade de resposta doentes tratados/pedido de acesso; avaliação inicial e periódica das necessidades (oito domínios); acessibilidade farmacológica; congruência entre os cuidados prestados e os desejados; prática regular de reuniões multidisciplinares; conferência familiar, pelo menos 2 vezes. Conclusões: No panorama nacional, não se conhecem indicadores unanimemente ratificados como adequados à avaliação da efectividade, qualidade e eficiência dos cuidados paliativos. Por outro lado, atento o objectivo do presente trabalho, a informação recolhida a nível internacional devolveu indicadores aplicáveis maioritariamente num contexto da avaliação da prestação dos cuidados paliativos, e Indicadores de Qualidade para a Contratualização de Cuidados Paliativos em Portugal x/ 93 não tanto num contexto de um processo de contratualização efectivo. Assim, partindo destes indicadores, em utilização nos vários países estudados, o estudo permitiu identificar sete indicadores considerados como adequados para a contratualização destes cuidados, em Portugal. -------------- ABSTRACT - Scope and objectives: This work focuses on the palliative care area, in particular, aims to contribute to greater effectiveness of the monitoring and procurement process of this type of care. In this context, as the main objective of the study, key indicators were identified regarding the quality issue, crucial to the conceptualization of a contracting model, and consequently to ensure the monitoring, supervising and evaluating of the undertaken activities. Method and methodology: Initially, a documentary research was held. That research aimed to surveying the indicators in their dimension of quality, regarding their use in palliative care throughout several countries. The chosen countries already had validated indicators, namely, Canada, United Kingdom , Australia, Spain and the USA. Thus, the indicators selected were common to all the above mentioned countries, for discussion purposes and agreement, as part of a Nominal Group Technique, that could integrate a model of contracting in this area in Portugal. Presentation and result discussion: The documentary research resulted in 188 quality indicators in use in the referred countries, 19 of those indicators were common to all countries. These indicators were submitted for discussion and agreement at a meeting of experts, having been ranked the seven most appropriate indicators for palliative care contracting: composition of an interdisciplinary team; response ability to the patients / access requests, initial and periodic assessment of the needs (eight areas), pharmacology accessibility; congruence between the desired care and its effective provision and regular practice of multidisciplinary meetings, family conferences, at least two times. Conclusions: In the national scene, unanimously ratified as suitable indicators to assess the effectiveness, efficiency and quality of palliative care are unknown. On other hand, given the objective of this work, the international collection of information has given applicable indicators mostly in the context of assessing the provision of palliative care, rather than an effective contracting process context. Thus, based on these indicators in use in the studied countries, the study itself identified seven indicators considered appropriate for the contracting of such care in Portugal.

Foresight methodologies to understand changes in the labour process. Experience from Portugal

The foresight and scenario building methods can be an interesting reference for social sciences, especially in terms of innovative methods for labour process analysis. A scenario – as a central concept for the prospective analysis – can be considered as a rich and detailed portrait of a plausible future world. It can be a useful tool for policy-makers to grasp problems clearly and comprehensively, and to better pinpoint challenges as well as opportunities in an overall framework. The features of the foresight methods are being used in some labour policy making experiences. Case studies developed in Portugal will be presented, and some conclusions will be drawn in order to organise a set of principles for foresight analysis applied to the European project WORKS on the work organisation re-structuring in the knowledge society, and on the work design methods for new management structures of virtual organisations.

Risk management of new product development process

Dissertation submitted to Faculdade de Ciências e Tecnologia of Universidade Nova de Lisboa for the achievement of Integrated Master´s degree in Industrial Management Engineering

A green integrated process for biodiesel production

Dissertation presented at Faculdade de Ciências e Tecnologia from Universidade Nova de Lisboa to obtain the degree of Master in Chemical and Biochemical Engineering

Land use/ land cover change and its impact on soil erosion process in Begnas Tal Rupa Tal watershed using geospatial tools, Kaski district, Nepal

Dissertation submitted in partial fulfilment of the requirements for the Degree of Master of Science in Geospatial Technologies

Design and testing of a radiation hardened 13-bit 80 MS/s pipeline ADC implemented in a 90nm standard CMOS process

Second International Workshop on Analog and Mixed Signal Integrated Circuits for Space Applications (AMICSA 2008), Sintra, Portugal, Setembro de 2008

Innovation through virtual communities of practice: motivations and constraints in the knowledge-creation process

This paper appears in International Journal of Projectics. Vol 4(1), pp. 39-49

Numerical Method to Predict Void Formation during The Liquid Composite Molding Process

Void formation during the injection phase of the liquid composite molding process can be explained as a consequence of the non-uniformity of the flow front progression. This is due to the dual porosity within the fiber perform (spacing between the fiber tows is much larger than between the fibers within in a tow) and therefore the best explanation can be provided by a mesolevel analysis, where the characteristic dimension is given by the fiber tow diameter of the order of millimeters. In mesolevel analysis, liquid impregnation along two different scales; inside fiber tows and within the open spaces between the fiber tows must be considered and the coupling between the flow regimes must be addressed. In such cases, it is extremely important to account correctly for the surface tension effects, which can be modeled as capillary pressure applied at the flow front. Numerical implementation of such boundary conditions leads to illposing of the problem, in terms of the weak classical as well as stabilized formulation. As a consequence, there is an error in mass conservation accumulated especially along the free flow front. A numerical procedure was formulated and is implemented in an existing Free Boundary Program to reduce this error significantly.

Downstream processing development of enveloped viruses for clinical applications: innovative tools for rational process optimization

Dissertation presented to obtain a Ph.D. degree in Engineering and Technology Sciences, Biotechnology at the Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa

Using perspective schema and a reference model to design the ETL process

Dissertação apresentada para a obtenção do Grau de Doutor em Informática

A process-based control for evolvable production systems

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para a obtenção do grau de Mestre em Engenharia Electrotécnica e de Computadores

Establishing a high titer transient gene expression process in conditioned media for CHO-DG44 cells

Dissertação para obtenção do Grau de Mestre em Biotecnologia

Dynamics of cork mycobiota throughout stopper manufacturing process: from diversity to metabolite

Dissertation presented to obtain the Ph.D degree in Biology

Reconstitution of the failure of the Fonte Santa mine tailings dam. Modelling of the dam breaching process

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia Civil Perfil de Estruturas e Geotecnia

Process engineering of liver cells for drug testing applications

Dissertação para obtenção do Grau de Doutor em Bioengenharia