Fatores da satisfação, fidelidade e recomendação em serviço de saúde: estudo em setor ambulatorial de hospital

This thesis deals with the factors affecting customer satisfaction, loyalty and recommendation in the health care sector. It is adapted a model proposed by Johnson et al. (2001) of quality and loyalty antecedent factors and it is conducted a survey with a sample of 109 customers of a hospital on the ambulatory in Natal city, a capital of a Northeastern State of Brazil. It is carried descriptive and multiple regression statistical analysis. The main findings related to satisfaction are that quality factors of doctor professionalism, clerical staff efficiency, consultancy room comfort, time to provide the medical consultancy but also hospital localization are the most significant factors affecting satisfaction. Regarding personal full loyalty, satisfaction with the hospital and affective commitment are the main factors yet for partial loyalty image and calculate commitment play the main role. For recommendation satisfaction, image and brand are the main factors. The overall model used fairly explains the satisfaction, loyalty and recommendation outcomes with varying factors regarding each final purpose, e.g. loyalty or recommendation

Fatores que afetam a satisfação de pacientes em serviços de saúde :um estudo em setor ambulatorial de hospital

This thesis shows concepts and models related to customer satisfaction measurement, focusing in detail on patients satisfaction evaluations in a policlinic sector of a hospital located in Natal RN. To reach this aim, two hundred and fifty one patients of this hospital were interviewed. The methodology approach includes a theoretical basis through a review and study of previous research on the topic, governmental initiatives and management systems which deal with excellence and need more reports concerning customers perceptions about satisfaction. Furthermore, it was included some models of nationals index about customer satisfaction. The Norwegian model was used in this thesis. The use of this approache, together with a multiple regression analysis, led to results that shows the factors which affect patients satisfaction in a policlinic sector. They are four as following: The evaluation of physician attendance; its results; simplicity of accessibility when health services are needed; and both support and tranquility given by the hospital. The study results can support researches of a conceptual model to determinate the aspects which affect the patient s satisfaction and could be a contribution to a development of a national costumer satisfaction index

Qualidade em serviços de saúde: uma contribuição à definição de um modelo paramétrico e padrão de qualidade do tempo agendado para consulta ambulatorial

This work presents a study in quality of health care, with focus on consulting appointment. The main purpose is to define a statistical model and propose a quality grade of the consulting appointment time. The time considered is that from the day the patient get the appointment done to the day the consulting is realized. It is used reliability techniques and functions that has as main characteristic the analysis of data regarding the time of occurrence certain event. It is gathered a random sample of 1743 patients in the appointment system of a University Hospital - the Hospital Universitário Onofre Lopes - of the Federal University of Rio Grande do Norte, Brazil. The sample is randomly stratified in terms on clinical specialty. The data were analyzed against the parametric methods of the reliability statistics and the adjustment of the regression model resulted in the Weibull distribution being best fit to data. The quality grade proposed is based in the PAHO criteria for a consulting appointment and result that no clinic got the PAHO quality grade. The quality grade proposed could be used to define priority for improvement and as criteria to quality control

Qualidade em serviços de saúde: uma contribuição à definição de um modelo paramétrico e padrão de qualidade do tempo agendado para consulta ambulatorial

The knowledge management has received major attention from product designers because many of the activities within this process have to be creative and, therefore, they depend basically on the knowledge of the people who are involved in the process. Moreover, Product Development Process (PDP) is one of the activities in which knowledge management manifests in the most critical form once it had the intense application of the knowledge. As a consequence, this thesis analyzes the knowledge management aiming to improve the PDP and it also proposes a theoretical model of knowledge management. This model uses five steps (creation, maintenance, dissemination, utilization and discard) through the verification of the occurrence of four types of knowledge conversion (socialization, externalization, combination and internalization) that it will improve the knowledge management in this process. The intellectual capital in Small and Medium Enterprises (SMEs) managed efficiently and with the participation of all employees has become the mechanism of the creation and transference processes of knowledge, supporting and, consequently, improving the PDP. The expected results are an effective and efficient application of the proposed model for the creation of the knowledge base within an organization (organizational memory) aiming a better performance of the PDP. In this way, it was carried out an extensive analysis of the knowledge management (instrument of qualitative and subjective evaluation) within the Design department of a Brazilian company (SEBRAE/RN). This analysis aimed to know the state-of-the-art of the Design department regarding the use of knowledge management. This step was important in order to evaluate in the level of the evolution of the department related to the practical use of knowledge management before implementing the proposed theoretical model and its methodology. At the end of this work, based on the results of the diagnosis, a knowledge management system is suggested to facilitate the knowledge sharing within the organization, in order words, the Design department

As quatro operações básicas: uma compreensão dos procedimentos algorítmicos

The current research had as main objective to analyze the possibility of knowledge elaboration/re-elaboration about ideas and algorithmic procedures related to basic operations by pupils of the 6th degree fundamental teaching in a significant learning process. This way the study had as basis a methodological intervention developed in a 6th degree class of a Fundamental Teaching Municipal School in the city of João Pessoa, PB. The research had as central steps the application of pre-tests (1 and 2); the execution of semi-structured interviews with the pupils involved in the theme deep studies; the elaboration and development of teaching activities, having as referential the significant learning and the application of a pre-test. The data collected in the pre-tests (1 and 2) showed a low level of the pupils comprehension about the contents related to the four operations. The answers to the post-test questions were analyzed mainly from the qualitative point of view based on the mathematic concepts comprehension theory proposed by Skemp (1980) having as complementary subsidy data collected through interviews. The analysis of the results obtained in the post-test showed that the major part of pupils reached a relational comprehension about the ideas and algorithmic procedures related to addition, subtraction, multiplication, and division. Such results showed us that the application of a teaching methodology that privileges the content comprehension, considering the pupils previous knowledge and the reflection about the action along the activities proposed, made possible the elaboration or re-elaboration of knowledge by pupils regarding to contents adopted as theme for our research

Procedimentos de abertura e fechamento de tópicos na interação em sala de aula

This study is part of interactional perspective, focusing on Conversation Analysis theories, from the Textual Interactive Perspective and Text Linguistics . This research, from its guiding questions, aims at understanding the interaction between teacher and students in the process of the knowledge construction as well as at describing, analyzing and understanding aspects of topical organization speech in the classroom in elementary school, observing the opening and closing procedures of the speech topics in that particular space. Considering that the procedures for opening and closing of discursive topics occur through language marks, we tried to identify which speech marks are used in the opening and closing of the topics studied in the classroom, in interaction during the collaborative process of the discourse established between teacher and students. Therefore, this study is based on authors who analyze specific questions of the text in real context of language use: Koch (1993, 1999), Jubran et al (1991), Jubran (2006), Pine (2005), Penhavel (2010), Galembeck (2012), Barros (1991), Marcuschi (1986 , 1990, 1991 , 1998 , 1999, 2003 , 2004a), Kerbrat - Orecchioni (2006), Favero (1999, 2002) and Galvão (2004, 2010). As a methodology of investigation, the study is focused on the postulates of ethnographic research in order to carry out data collection, through audio and video recordings which were transcribed, according to the NURC project proposal, with some adaptations. Data analysis showed that the procedures for opening and closing of the speech topics occurred by the use of discourse markers, in particular the marker "then", allowing us to understand that these elements are important in the topical organization speech, contributing to ensure textual cohesion and coherence. We conclude that the organization of the discursive topic in the classroom occurs through events that support the explicitness of the content of teaching and learning, considering the diverse necessity of an institutional academic plan, whose main objective is the construction of knowledge

Revisitando o eletrocorticograma intra-operatório na epilepsia mesial do lobo temporal: relevância das oscilações de alta frequência

Epilepsies are neurological disorders characterized by recurrent and spontaneous seizures due to an abnormal electric activity in a brain network. The mesial temporal lobe epilepsy (MTLE) is the most prevalent type of epilepsy in adulthood, and it occurs frequently in association with hippocampal sclerosis. Unfortunately, not all patients benefit from pharmacological treatment (drug-resistant patients), and therefore become candidates for surgery, a procedure of high complexity and cost. Nowadays, the most common surgery is the anterior temporal lobectomy with selective amygdalohippocampectomy, a procedure standardized by anatomical markers. However, part of patients still present seizure after the procedure. Then, to increase the efficiency of this kind of procedure, it is fundamental to know the epileptic human brain in order to create new tools for auxiliary an individualized surgery procedure. The aim of this work was to identify and quantify the occurrence of epilepticform activity -such as interictal spikes (IS) and high frequency oscillations (HFO) - in electrocorticographic (ECoG) signals acutely recorded during the surgery procedure in drug-resistant patients with MTLE. The ECoG recording (32 channels at sample rate of 1 kHz) was performed in the surface of temporal lobe in three moments: without any cortical resection, after anterior temporal lobectomy and after amygdalohippocampectomy (mean duration of each record: 10 min; N = 17 patients; ethic approval #1038/03 in Research Ethic Committee of Federal University of São Paulo). The occurrence of IS and HFO was quantified automatically by MATLAB routines and validated manually. The events rate (number of events/channels) in each recording time was correlated with seizure control outcome. In 8 hours and 40 minutes of record, we identified 36,858 IS and 1.756 HFO. We observed that seizure-free outcome patients had more HFO rate before the resection than non-seizure free, however do not differentiate in relation of frequency, morphology and distribution of IS. The HFO rate in the first record was better than IS rate on prediction of seizure-free patients (IS: AUC = 57%, Sens = 70%, Spec = 71% vs HFO: AUC = 77%, Sens = 100%, Spec = 70%). We observed the same for the difference of the rate of pre and post-resection (IS: AUC = 54%, Sens = 60%, Spec = 71%; vs HFO: AUC = 84%, Sens = 100%, Spec = 80%). In this case, the algorithm identifies all seizure-free patients (N = 7) with two false positives. To conclude, we observed that the IS and HFO can be found in intra-operative ECoG record, despite the anesthesia and the short time of record. The possibility to classify the patients before any cortical resection suggest that ECoG can be important to decide the use of adjuvant pharmacological treatment or to change for tailored resection procedure. The mechanism responsible for this effect is still unknown, thus more studies are necessary to clarify the processes related to it

Indicadores da resposta ao estresse agudo associados com a familiaridade ao ambiente e aos procedimentos de banho e tosa em cães (Canis familiaris) da raça poodle

The stress responses can be parameters used in order to identify the welfare of animals. Behavior parameters can also be regarded as means to identify their relation to stressing situations. In this study, adult male and female poodle dogs, accustomed (group 1) or not (group 2) to the environment of a bath and grooming salon were analyzed through the plasmatic concentration of cortisol, cell counting of the immune system (total leukocytes and percentage of neutrophils and lymphocytes) and through observation of changes in behavior before and after the bath and grooming service. After arriving at the kennel, the dogs were taken to the bath and grooming facility, where they had their blood samples taken and were observed for ten minutes. The subsequent procedures consisted of the bath and grooming services and the collection of another blood samples. The research results were analyzed through non-parametric statistic tests and p < 0.05. Accustomed and non-accustomed dogs presented different hormonal and behavior responses: accustomed dogs presented an increasing of the cortisol level at the second blood samples collection, thus indicating stress towards the aforementioned procedures and presenting behavior responses which can be described as moderated stress. Non-accustomed dogs presented the same cortisol levels in both first and second samples suggesting that they were already reacting to the new environment. Dogs also shown behavioral responses which can be described as acute stress. Both male and female dogs showed similar immunological changes as well as different endocrine and behavioral profiles. Concerning aggression, this study demonstrates that biting the owner can be a predicting behavior of aggression during the bath and grooming service, male dogs were more aggressive than the female, and that males were more reactive to unknown caretaker. The results of this research propose that the familiarization of the animal with the bath and grooming environment and caretaker is important to the welfare of poodle dogs, especially to that of male dogs

O Serviço Ambulatorial Móvel de Urgência (SAMU) no contexto da reforma psiquiátrica: em análise a experiência de Aracaju/SE

This research investigated professional practices from Mobile Urgency Care Service (Serviço Ambulatorial Móvel de Urgência - SAMU) at psychiatric cases of the city of Aracaju/SE, Brazil and its possible articulations to psychosocial services network. The regulation no. 2048 of 11/05/2002 from Ministry Health establishes National Urgency Policy and designates that psychiatric cases are SAMU's responsibility. Then, it is necessary to propose an analyze of psychiatric urgency service under anti-asylums social movements standpoint, mainly because this service is responsive in assisting a person in crises. Fieldwork was developed in two phases. First one was made with SAMU workers and the information were produced by recorded semi-structured interviews. Results of this first phase indicate that urgency psychiatric conception from SAMU workers is based on aggressiveness concept; delays at psychiatric cases support and low training in mental health care which means several difficulties to emergency service. Although, we noticed that SAMU use asylum procedures at psychiatric cases like ropes and odder instruments to contain people. The second step of our research was to attend meetings to build a new psychiatric urgencies protocol for SAMU to define practices to auxiliaries, vehicular conductors and medical support regulation. Therefore, open interviews were accomplished with some participators and follows-up to psychiatric case on board of SAMU's cars. Afterwards we discussed how the urgency paradigm, that influence the protocol draw and as consequence distort what we believe is the essentially function of this device, that is to give care support to persons in crises and produce articulation to psychosocial services network

A CRONIFICAÇÃO NOS SERVIÇOS SUBSTITUTIVOS NA REDE DE SAÚDE MENTAL DE NATAL/RN

Brazilian Psychiatry Reform, through Psychosocial Care Strategy, has intended to build insane people care practices from community care services which contemplates the subjects complete lives. However, to change the traditional care ways demands the facing of a series of epistemological, political and cultural obstacles. One of the current challenges deals with patients aggravation processes, with management ways, with devices and with professionals, as well as with the assistance network. The purpose of this thesis was to investigate how these aggravation processes has been constituted in Natal mental healthcare network, understanding its effects in the work teams and patients. Theoretical and methodological perspective used was Institutional analysis was, subsidizing the usage of concept-tools as the implication analysis, selfmanagement and self-analysis, and restitution. The research was carried out at the Natal East Sanitary District Mental Healthcare Clinic, with the participation of technicians and patients. The research procedures were: literature and document research on the attendance and the analyzed theme; attendance registers analysis; participating observation of the institutional routine for three months and field log entries; talking groups, one with the team and one with the patients. Two main discussion points are shown: 1. The mental healthcare clinic organization logic and the intersector politics; 2. The work and management processes developed at the mental healthcare clinic. The analysis show diversity in the attended demands in the service, which has favored the patients aggravation, this device and the substitute network processes. The work processes are apart from the political sphere and from the managements processes. In this sense, we show the need to reevaluate the clinic device as well as the management models adopted in the Brazilian Psychiatry Reform context

Elaboração de material pré-composicional através de expansão de procedimentos do sistema Schillinger de composição musical

The work aims at investigating possibilities of extending compositional procedures, based on the Schillinger System of Musical Composition (SSMC). I start by elaborating a brief historical review on SSMC, which is followed by a critical review of the System. The work includes a state of the art on the research on this topic, performed upon analysis of the current work conducted by a research group from the UFRN Music School from which I also make part. The main line of the research is to elaborate on the suggestion of extending the SSMC concept of place of attack to the idea of place of instrumentation, through developing a binary instrumentation procedure. The experimentation on the thesis‟ hypothesis is presented in my composition titled “Suíte Grega” (Greek Suite), a compositional memoir for Oboe, Saxophone and 3 Cellos.

O registro de procedimentos metodológicos em projetos de intervenção arquitetônica no patrimônio edificado: o caso de Natal-RN

In the midst of growing preservationist awareness, regarding methods of architectural intervention of buildings with a recognized heritage value, there are numerous approaches on how the original heritage value can be protected. However, can these intervention projects be differentiated? Is it possible to identify how they differ (if in fact they do) from an architectural project not related to preservation? Although there are numerous theoretical studies regarding methods utilized in architectonical projects, there appear to be a lack of studies focused on an architectural intervention exclusively focused on areas or edifications that have a recognized heritage value, thereby requiring a reflection on which methodological procedures in an architectonical project serve the purpose of the preservation of the historical aspects. This discussion is of even greater importance because, at the national level, some recent discussions on this type of architectural design seem arbitrary and lack methodological rigor. Therefore, this research attempts to focus equally on the theoretical-methodological practices of preservation as well as the architectural project methods. In an attempt to address these aspects, the focus of this research centers on the case studies of the intervention projects of the maritime passenger terminal of Natal (Terminal Marítimo de Passageriros de Natal), the old government hall (Palacio do Governo - EDTAM) and the old central hotel (Hotel Central) which are situated in the area known as the historic downtown of the city of Natal, within the federal heritage protection polygon. The analyses of these is intended to identify what methodological procedures were recorded in the final product (in the graphical representation of the architectural design and other documents) delivered to IPHAN / RN, the body responsible for review and approval of these architectural projects, noting whether such procedures appear, in some way, in the final product, and if an understanding of the complexity of preservation is evident. The analyses of these projects corroborate the hypothesis that there are unique characteristics, which must be addressed in the intervention project for preservation when compared to new project design. The main characteristic to be addressed is related to the very nature of the project. It is inherent in the dialectical relationship between the need to preserve (the identified heritage values) and the need to modernize (making adaptations to contemporary life). This relationship, denominated in this dissertation as "radical restraint", must, or at least should, guide the actions in the project as well as the technical analyses of the preservationist organization. However, this radical restriction appears more evident in the guidelines put forth by legislators than in the decisions of designers. These legislators require the presentation of documents, aimed at identifying and contextualizing intervention (Ordinance No. 420 of December 22, 2010), that grant (or should grant) assistance in the decision making process. It was evident in the analyses of these documents that there existed a disconnect between the documents produced and the decisions made in the project. This fact can be seen in the total absence of dialogue about theoretical-methodological preservationist principles, which, in our view, is an essential element of the methodological procedures of the intervention project needed to guide the legislative and project design discussions.

Procedimentos legais e protocolos sobre a sistemática de aquisição de cadáveres na Universidade Federal do Rio Grande do Norte para o ensino de anatomia humana

A disponibilidade de cadáveres para estudo e pesquisa vinha sendo feita tradicionalmenteutilizando-se corpos não reclamados sem grandes formalidades. Com a complexidadejurídica, social, ética e moral dos tempos atuais, o simples encaminhamento dessescorpos ao Departamento de Morfologia da Universidade Federal do Rio Grande do Norte,passou a ser temido com o receio de transgredir a legislação penal. Isso desencadeouuma redução no número de cadáveres para as aulas práticas de Anatomia. Essarealidade levou o Departamento de Morfologia da Universidade Federal do Rio Grande doNorte a pesquisar mecanismos legais que solucionassem a escassez de cadáveres parao estudo e pesquisa. A metodologia utilizada constou de reuniões de discussão eapresentação de protocolos de aquisição de cadáveres com base na legislação vigente.Os resultados obtidos foram: (1) Publicação do provimento 093/2012 da CorregedoriaGeral da Justiça do Tribunal de Justiça do Estado do Rio Grande do Norte, que dispõesobre o registro de óbito dos cadáveres destinados às escolas de Medicina para fins deensino e pesquisa; (2) Elaboração de protocolos para aquisição de cadáveres nãoreclamados junto às instituições; (3) Programa de doadores voluntários na UniversidadeFederal do Rio Grande do Norte.Por fim, concluímos que o conhecimento das atribuiçõespor parte das instituições públicas e privada, bem como o programa de doação voluntáriaaumentaram a oferta de cadáveres para o ensino da Anatomia Humana na UniversidadeFederal do Rio Grande do Norte.

Caracterização socio-econômico-cultural de raizeiros e procedimentos pós-colheita de plantas medicinais comercializadas em Maceió, AL

ARAUJO, Afranio Cesar de et al. Caracterização socio-econômico-cultural de raizeiros e procedimentos pós-colheita de plantas medicinais comercializadas em Maceió, AL. Rev. Bras. Pl. Med, Botucatu, v. 11, n. 01, p.81-91, 2009. Disponível em: . Acesso em: 04 out. 2010.

Projeto do complexo ambulatorial do Hospital Universitário João de Barros Barreto visando a critérios de sustentabilidade

The purpose of this dissertation is the architectural project of the ambulatory complex of the Federal University of Pará in Belém. It is a health care establishment whose focus is sustainability, energy efficiency and humanization. This design went through the application of architectural concepts, the study of references (theorical and empirical ones), planning, examining the terrain and its conditions and the preliminay design and resulted in a preliminary architecture blueprint. The empirical research is based on the main building of the Hospital Universitário João de Barros Barreto in Belém, Hospital Sarah Kubitschek of Fortaleza (Architect João Filgueiras de Lima - Lelé) and Hospital e Maternity São Luiz of São Paulo (Architect Siegbert Zanettini). Part of the planning is based on the method "Problem Seeking of Pena and Parshal (2001)". During the development process I sought to incorporate sustainability criterias, energy efficiency and humanization. In relation to sustainability the dissertation focuses on the utilization of rainwater for non-potable usage