A propaganda de medicamentos voltados à clínica obstétrica e/ou ginecológica e sua influência sobre a prescrição

INTRODUCTION: Drug advertisement stimulates self-medication and irrational use of medicines, especially when it starts to interfere in the prescription. Monitoring advertisements, as well as the observation of its influence on health professionals, prescriptions become necessary because of this public health problem. OBJECTIVE: The aim of this work was to analyze drug advertisements directed to gynecologists and/or obstetricians doctors relating them to the current legislation as well as its influence on prescription. METHODOLOGY: The sample was composed of drug advertisements divulged to the gynecologists and / or obstetricians doctors and was analyzed according to RDC96/2008. To evaluate the influence of advertisement on prescription, a questionnaire was administered to gynecologists / obstetricians doctors and prescriptions of a public maternity were also evaluated. RESULTS AND CONCLUSION: Concerning the advertisements analyzed, 48% complied fully with current legislation and 52% of the advertisements analyzed were in accordance to the RDC No. 96/2008 in most of the items evaluated. The doctors interviewed are used to receive the visits of propagandists, even in the public service, receiving gifts offered by the industry and believe that medicine advertisement tries to influence prescribing. Many of them use the material provided by the propagandist as a source for their prescription, although they present a critical view about them information. The use of trade name / mark on the prescription is a common practice among the doctors interviewed, even in the public service, suggesting there is an influence of medicine advertisement on the prescription

O direito social fundamental de acesso à energia elétrica e a atuação estatal

Electrical energy today is an essential element in the life of any human being. Through the access to electrical energy it is possible to enjoy dignified conditions of life, having in mind the possibility of making use of minimal material conditions of life. The lack of access to electricity is directly linked to poverty and degrading conditions of life, in which are some communities in Brazil, especially the more isolated from urban centers. Access to the electric service is a determining factor for the preservation of human dignity, constitutional principle inscribe in the art.1 of the Federal Constitution, and the promotion of development, being a right of everyone and a duty of the State to promote universal access. For that reason, focuses mainly on the analysis of their setting as a fundamental social right and its importance for national development. For this, the theoretical and descriptive method was used, with normative and literary analysis, in particular the Constitution of 1988. This study also discusses the form of action of the State in the energy sector, to give effect to the fundamental social right of access to electricity, the characteristics of public service and the principles that guide it, in addition to the role of public policies in universalization of access, in particular the analysis of the Program Luz para Todos, and the function of regulation in the implementation of these policies and the provision of adequate public services.

O município brasileiro e o direito fundamental do acesso à justiça: a prestação da assistência jurídica municipal ao necessitado

This scholarly work aims to investigate the feasibility and constitutionality of access to justice through the provision of full and free legal assistance by the Brazilian municipalities. Investigates the historical aspects of federalism in a global context, emphasizing the contributions left by American federalism. In the Brazilian context, emphasizing the importance of municipalities as federal entities and their outstanding characteristics, while addressing regional issues of federalism. Leanings to the more detailed analysis of the Brazilian municipalities, contextualizing its legal status, its independence and its constitutional powers. It is emphasized in the same way, the relevant transformations of Brazilian municipalities over the last twenty years of this Constitution of the Federative Republic of Brazil in 1988, especially the various constitutional amendments that affected the local autonomy and budgetary aspects, fiscal and skills, bringing significant changes to the municipalities. It is an approach to the concept of justice and deepening the studies on the fundamental right of access to justice in its various connotations. In this vein, it is a study on the legal advice provided in Brazil, especially the powers of the Public Defender of the States and Union, as well as the provision of such public service by Brazilian municipalities and its relevance to citizens in need. At this point, it deepens the relevance of the theme of this dissertation earning the implications of municipal performance in the provision of legal assistance provided to the needy, and the activity of the Municipal Attorney or legal counsel in conducting such a task and its implications for legal and procedural especially on the constitutionality or otherwise of the conduct of such public service, confronting the constitutional articles that are correlated with the subject. Within this context, evaluates the municipal legal assistance under the test of constitutionality, in particular the assistance given by the Executive, through the Municipal Attorney or specialized secretariats and that provided by the Legislature, although it only has the typical functions of legislating and control the municipal accounts, comes in a few municipalities in Brazil deploying sectors with the performance of legal services to the needy. At this point the thesis, one wonders if some important aspects of this activity such as political influence and patronage, very common in day-to-day municipal prosecutors and legal advisers, public employees or occupying commissioned positions within the municipal administrative structure in several municipalities throughout Brazil. Finally, there will be a conclusion as to the constitutionality of the service being done by presenting proposals and recommendations that may improve the municipal legal aid, allowing a constitutional backing to this important service is being provided in capital cities and municipalities throughout the length of Brazil

Defensoria pública e sua legitimidade à tutela jurídica dos direitos humanos

The realization of human rights is a prerequisite to the development of peoples, this requires legal mechanisms and techniques to its consistent and effective promotion, protection and fulfillment. So, agree that there is an institution or public agency created for the purpose of protecting those who suffer most in the face of human rights violations: the needy. In Brazil, among other institutions and public agencies, the responsibility of the Public Defender to promote the protection of human rights. The constitutional system recognizes the institution in its essence the role of the state court, whose duty is to provide guidance and legal defense of the needy. The legal system as a whole sufraga the relevance of the Ombudsman as a mainspring of human rights. In the prison system, with the ultimate regulatory changes, such as Law 12.313 of 2010 which introduced changes to the Law 7.210 of 1984, the institution must ensure the correct and humane enforcement of sentences and the security measures pertaining to the needy. With the Complementary Law 132 of 2009, to systematize other duties of the Public Defender, highlighting their contribution to the movement of access to justice. Within the OAS, to adopt Resolution 2656, 2011, characterizing, with ruler and compass, the relevance of the Ombudsman access to justice and protection of human rights. In this step, the present study concerns the role of Defender in the legal protection of human rights, through monographic and deductive methods, as there remains a technical and theoretical connection between these two points themed legal phenomenon, since the rights humans, especially after the second half of the twentieth century, form the basis of the legal system of the major Western nations in the world. This led, therefore, the emergence of technical and legal institutions aimed at realizing human rights. This applies to the Defender. Access to justice and public service provision of legal assistance are human rights, therefore, essential to humans and necessary for social inclusion. Countries such as Brazil, marked by social inequality, depend on the structuring of institutions like the Defender, designed to promote citizenship to the Brazilian people

A constitucionalização da solução pacífica de conflitos na ordem jurídica de 1988

In the Brazilian legal context, conflict resolution is studied and analyzed over a majority jurisdictional view, which is one of the reasons of litigation culture that creates a jurisdictional resolution hopeness. The practical impact of such reality is the loss of quality in the public service of the judicial function, moved, as a rule, by the overcrowdings, slowness of legal procedures and the relegation of peaceful resolution methods to peripheral plan. However, the Federal Constitution of 1988, following the Ordinary Law constitutionalization phenomenon provides specific guidance about the values towards the litigation resolution. The study, therefore, aims to approach the constitutionalization of conflict resolution in order to identify, through scientific and spiritual interpretation in conjunction with the systematic paradigm, what are these values, as well as operation and legal representation and practice of these measurements. In this sense, the thesis is to study the initial point of the analysis of conflict theories and explanations about the culture of litigation matched with concepts of creation and interpretation, constitutionalization, access to justice and social pacification public policies. It is used for this purpose, the logical-deductive method with the aid of the dialectic immanent in Law

A Servidão Administrativa e o Estado Regulador: Compatibilidade com o Princípio Constitucional da Legalidade e a Limitação ao Direito Real de Propriedade

The economic changes occurred in the 90s, with the restructuring and privatization of various sectors of the economy have led to a redefinition of the State role, assuming a position of regulator and supervisor of public services in place to direct its role as straight intervenor. It is through the regulatory agencies, autarchies with special legal personality under public law, that the Regulator State will act. In this context, the first objective of this research is to analyze the legality of easements imposed by entities of the Direct Administration and Regulatory Agencies, whose execution is delegated to legal persons of private law, being those public service companies or mixed-economy societies. This examination in question the limits of servitude as a restrictive institute of property rights, observing the principles of function, supremacy of the public interests over the private ones, legality and the separation of powers. Defend the property rights like a fundamental right and your insurance as determining factor of economic development and social justice. Use the procedure in use will be the historiccomparative procedure, in order to demonstrate the legality of the public act as a maximum attempt to preserve the balance between the expansion of public services in various sectors of the economy, and the preservation of property rights, through regulation

Aumento da jornada de trabalho :qual a repercussão na vida dos trabalhadores da enfermagem?

The worker of the public service is loosing your acquisitive power by means of the politics of fiscal settlement. The ways out that were found in the health sector, especially in nursing, is being the increasing workday for beyond 40 or 20 hours established in the link of the work with the state. This survey has the object to identify the possible repercussion of the increasing workday in daily life workers from nursing in the public service of Rio Grande do Norte. The theory reference used was the work of Marx (1982) and Antunes (2000,2001) and the daily living in Heller (1991,1992). The methodology used was a qualitative survey in the exploration kind. The informations were gathered through interviews with open questions almost structured with workers of nursing, managers and representatives of entity. The analysis of informations were made through general categories, work, and daily life, using elements from dialetics-hermeneutics according to Minayo (1992,2002). In the analysis, it was identified that the ways that were found for the overcoming of the loss of acquisitive power were the many-employment; the extra scale of shift; the subletting of work posts and the substitution of friends in scales of work, and all of them being changed in increase. Other aspect realized was the move of rights, like vacation and medical license for the workers that act in extra scale. The tiredness, stress, and bad humor are influents factors in the development of work.. The reduction of free time makes in the workers ahguish because of the familiarity decreasement just as time to dedicate themselves to the technical-scientific improvement and for the cultivation of other aspects of subjectivity, as leisure, care and culture. The low salary and the non reajustment are the reasons for the adoption of part workers for the increasing workday, and government has been responsible for this situation. The conclusion was that the increasing workday has strong repercussions in the professional and personal daily life workers that made part of the survey

Utilização do Balanced Scorecard na gestão pública : um estudo de caso na Polícia Militar do Estado do Rio Grande do Norte

This dissertation deals with the use of the Balanced Scorecard (BSC) in the Military Police of Rio Grande do Norte (PMRN), an organization of service delivery in the area of public safety. For this purpose we sought refuge in the company's own documents, which presented the mission, vision and strategic objectives, which are items essential to the development of the instrument and its prospects. With the general objective of developing the BSC to PMRN, fitting into the methodology in a single case study, that from the desk study and according to their development, we established the classification of goals to the generic models and the BSC then adjusted according to public understanding of the corporation presented by professionals in the process of collection and in-depth interviews. Thus emerged the strategy map PMRN, based on the presentation of the causes and effects between the strategic objectives of each perspective, the value proposition to customers, internal processes needed to meet this value proposition and intangible assets, which are the basis to execute these processes

Perspectivados cirurgiões-dentistas sobre a inserção da fisioterapia na atenção básica de saúde

This work aims at investigating the surgeons-dentists acceptability in the field of public health in the city of Natal, State of Rio Grande do Norte, about the possibility of medicinal plants insertion in basic attencion of health. Moreover, it searchs to know if during their professinal formation it had some theoretician-pratical basement on this subject, as well as investigating their confidence on the medicinal plants. The basic motivation for developing this study is the possibility of contributing to the insertion of a tradicional health pratical at public assistance scope, endorsed by popular use, but now scientifically proven. For in a such way, the medicinal plants use is emphasized as a way to be followed to increase basic pharmaceutical assistance, improving the acess to the medicine and diminish expenses. Following this logic, family health program constitutes the way through which this pratical will be available to the users of health services. The research was done over thirty surgeonsdentists, all ofthem pertaining to public service ofNatal, state ofRio Grande do Norte. It was used, as research instrument, semi-estructured interview associated with methodological analysis user s speeches. On this form, this work is inserted in a trend observed nowadays not only in Brazil, where the use of the medicinal plants has been stimulated and defended to be inserted at programs ofprimary attenction of health

Prevalência e fatores associados à morbidade materna: inquérito populacional em Natal/RN

INTRODUCTION: Severe maternal morbidity , also known as maternal near miss , has been used as an alternative to the study of maternal mortality , since being more frequent shares the same determinants and enables the implementati on of epidem iological surveillance of cases . Since then, hospital audits ha ve been carried out to determine the rates of maternal near miss, its mai n causes and associated factors . More recently, population surveys based on self - reported morbidity have als o been presented as vi able in identifying these cases . OBJECTIVE: The aim of this study was to determine the prevalence and associated factors of maternal near miss and complications during pregnancy and puerperal period in Natal/RN. METHODS: A cross - secti onal population - based study was conducted in Natal /RN , Brazil, which has as its target population women aged 15 to 49 years who were pregnant in the last five years. It was carried out a probabilistic sam pling design based on a multi - stage complex sample , in which 60 census tracts were selected from three strata (north , south - east and west). Afterwards, domiciles were visited in order to obtain a sample of the 908 eligible women in whom a questionnaire was applied. The descriptive analyzes and bivariate ass ociations were performed using the Chi - square test and the estimate of the prevalence ratio (PR ) with 95% confidence interval (CI) and considering the weights and design effects . The Poisson regression analysis , also with 5% significance and 95% CI, was us ed for analyzes of associated factors. RESULTS: 848 women were identified and interviewed after visits in 8.227 households corresponding to a response rate of 93 . 4 %. The prevalence of maternal near miss was 41 . 1 /1 000NV, being the Intensive Care Unity stay i ng (19 . 1 /1 000 LB ) and eclampsia (13 . 5/1000LB) the most important marker s . The prevalence of complications in the puerperal peri od was 21 . 2 %, and hemorrhage (10 . 7%) and urinary tract infection (10 . 7%) the most frequently reported clinical conditions and rema in ing in the hospital for over a week after delivery the mo st frequent intervention (5.4%) . Regarding associated factors , the bivariate analysis showed an association between the increased number of complications in women of black/brown race ( PR= 1 . 23; CI95 % : 1 . 04 - 1 . 46) and lower socioeconomic status ( PR= 1 . 33; CI95%: 1 . 12 - 1 . 58) in women who had pre natal care in public service ( PR= 1 . 42; CI95%: 1 . 16 to 1 . 72 ) and that were not advised during prenatal about where they should do the d elivery (PR= 1 . 24; CI95%: 1 . 05 - 1 . 46), made the del ivery in the public service (PR= 1 . 63; CI95%: 1 . 30 - 2 . 03), had to search for more than one hospital for delivery (PR=1 . 22; CI95%: 1 . 03 - 1 . 45) and had no companion during childbirth ( PR =1 . 19; CI95%: 1 . 01 - 1 . 41) or at all times of childbirth c are - before, during and after childbirth - ( PR= 1 . 25, CI95%: 1 . 05 - 1 . 48) . Moreover, the number of days postpartum hospitalization was higher in women who had more complications (P R= 1 . 59 ; CI95%: 1 . 36 - 1 . 86). In the final regression model for both birth place (P R= 1 . 21 ; CI 95% : 1 . 02 to 1 . 44 ) and socioeconomic status (PR = 1.54 ; CI95%: 1 . 25 - 1 . 90 ) the association remained. CONCLUSION : Conducting population surveys using the pragmatic definition of near miss is feasible and may add importa nt information about this ev ent . It was possible to find the expression of health inequalities related to maternal health in the analysis of both socioeconomic conditions and on the utilization of health services.

Imunidade recíproca e livre concorrência: considerações acerca de sua fruição por empresas estatais

This study begins with a brief overview of tax immu nities in general, dealing with the concept, legal, doctrinal ratings and limits. Then enters into the reciprocal immunity, since its birth in the United States, its justifica tions, until her current developments in the Brazilian Supreme Court, which has expanded it quite considerably. That Court has extended to state owned enterprises, even if pa id by public prices or rates, or if acts somewhat away from its essential functions, es pecially if they are public services provider. Given this linkage, these are also treate d in own topic, grounded in newer doctrinal proposals and less attached to historical formalisms (see such Supremacy of Public Interest over Private one). Public services are approached in its diversity, oblivious to traditional monolithic nature and accu stomed to the modern doctrine of fundamental human rights. It deals also the princip les of free enterprise and free competition, given that the public service provider s have lived intensely in this environment, be they public or private agents. In d ialectical topic, these institutes are placed in joint discussion, all in an attempt to in vestigate their interactions and propose criteria less generic and removed from real ity, to assess the legitimacy of the mutual enjoyment of immunity by certain agents. Sev eral cases of the Court are analyzed individually, checking in each one the app lication of the proposed criteria, such logical-deductive activity and theory of pract ice approach. At the end, the conclusions refer to a reciprocal immunity less rhe torical and ideological and more pragmatic and consequentialist. It is proposed the end to the general rules or abstract formulas of subsumption, with concerns on the one h and the actual maintenance of the federal pact, and on the other by a solid econo mic order without inapt advantages to certain players, which flatly contradicts the co nstitutional premises.

A inserção do técnico em saúde bucal na estratégia saúde da família no estado do Rio Grande do Norte

An oral health technician is a profession in odontology whose own functions are defined in FEDERAL LAW NUMBER 11889, which can act for prevention, recovery and promotion of oral health. According to the web site, Of Primary Health Attention Department. Health Ministry Of Brazilian Federal Republic, you can see through historical cover, as regards Health Family Strategy that, in Rio Grande Do Norte, There are nowadays eight TSB equipments in use. Objective: The aim of this study is to find out the reasons of the inclusion of those technicians in public service, no matter the importance of this work. Method: It is about a quantitive study and a kind of exploring type, taking into account that there are not any similar previous ones. We divide it into two parts: as regards the first one, these technicians were registered in a map using the information of the Formation Schools and Class Counsel to know how and where they are. During the moment of this study, an application (or no application) of the mouth health equipments was done. They tried to discover in this process which elements contribute to the efficiency (or not) of this technical work done all together in equipment work. As regards the second part, the coordinators of Municipal Mouth Health answered to a survay that contained open and closed questions through telephone calls. The sample was defined by a raffle taking into account the work contained in municipalities. Results: There are 1053 technicians.94,3% of them are women, devided in all the health regions. As regards interview, 96,9% of oral health coordinators considered that it is very important to have an oral health technician in odontology. 92,2% would reccomend its inclusion in equipments related to mouth health, dealing to familly health . 76% have never talked before to the Health Secretary in this municipality. this spreading out could be related to financial resources and 51,6% mentioned the importance of improving the physical structure to make this spreading out possible. Conclusions: Oral Health technicians in Rio Grande Do Norte are not being adequatly used by public service, because they do not introduce themselves or act as Oral Health auxiliaries. It is important to increase concience about the importance of this category in odontology. we also say it is necesasary to invert money in a reform of the Basic Health Unities and the inclusion of these workers. On the other hand the role of the state and the public health militancy is questioned in the fulfilment of this process

Alinhamento estratégico da TI: o caso da UFRN

It is considered that the Strategic Alignment IT is the first step within the IT Governance process for any institution. Taking as initial point the recognition that the governance corporate has an overall view of the organizations, the IT Governance takes place as a sub-set responsible for the implementation of the organization strategies in what concerns the provision of the necessary tools for the achievement of the goals set in the Institutional Development Plan. In order to do so, COBIT specifies that such Governance shall be built on the following principles: Strategic Alignment, Value Delivery, Risk Management, Performance Measurement. This paper aims at the Strategic Alignment, considered by the authors as the foundation for the development of the entire IT Governance core. By deepening the technical knowledge of the management system development, UFRN has made a decisive step towards the technical empowerment needed to the “Value Delivery”, yet, by perusing the primarily set processes to the “Strategic Alignment”, gaps that limited the IT strategic view in the implementation of the organizational goals were found. In the qualitative study that used documentary research with content analysis and interviews with the strategic and tactical managers, the view on the role of SINFO – Superintendência de Informática was mapped. The documentary research was done on public documents present on the institutional site and on TCU – Tribunal de Contas da União – documents that map the IT Governance profiles on the federal public service as a whole. As a means to obtain the documentary research results equalization, questionnaires/interviews and iGovTI indexes, quantitative tools to the standardization of the results were used, always bearing in mind the usage of the same scale elements present in the TCU analysis. This being said, similarly to what the TCU study through the IGovTI index provides, this paper advocates a particular index to the study area – SA (Strategic Alignment), calculated from the representative variables of the COBIT 4.1 domains and having the representative variables of the Strategic Alignment primary process as components. As a result, an intermediate index among the values in two adjacent surveys done by TCU in the years of 2010 and 2012 was found, which reflects the attitude and view of managers towards the IT governance: still linked to Data Processing in which a department performs its tasks according to the demand of the various departments or sectors, although there is a commission that discusses the issues related to infrastructure acquisition and systems development. With an Operational view rather than Strategic/Managerial and low attachment to the tools consecrated by the market, several processes are not contemplated in the framework COBIT defined set; this is mainly due to the inexistence of a formal strategic plan for IT; hence, the partial congruency between the organization goals and the IT goals.

A crise de legitimidade na democracia representativa e o desatendimento aos direitos fundamentais: um enfoque participativo-educacional

This study aims to bring reflection on the legitimacy crisis of the Brazilian representative democracy, which results in non-attendance of fundamental rights, regarding legal and social facts in light of the existing constitutional order and seeking solutions in more democratic procedures and in a more humane, critical, democratic and collaborative education. It has been an issue for some time the understanding that the authorities do not meet the basic needs of Brazilian citizens - the only way to make them autonomous and sufficiently able to conduct their lives in a competitive and globalized labor market. Such situation only worsened - as illustrated by the social movements in mid-2013 - when people took to the streets, showing a noticeable dissatisfaction with public services in general, and some other groups presenting specific complaints in those events. To find solutions or at least suggestions for the reflection of the problem found, a current approach to public authorities was necessary attempting to reveal how the constitutional order authorizes their operation and how - in fact - they act. In this endeavour, the legitimacy of power was discussed, involving the analysis of its origin, to whom it belongs and the legitimacy of deficit situations, concluding that it is only justified as it gets more democratic influence, with greater participation of people in its deliberations and decisions, with its plurality and complexity. Research carried out by official institutions was necessary to have evidence of the low level of social development of the country and the nonattendance of minimum basic rights, as well as exposure to various acts and omissions which show that all public authorities do not legitimately represent the people's interests. The competence of the Supreme Court to establish the broader scope of the remuneration policy in the public service received proper attention, presenting itself as an effective means to promote the reduction of the remuneration and structural inequality in public service and contributing to better care of fundamental rights. Also, considerations were made about the Decree 8243/2014, which established the National Policy for Social Participation (NPSP) and the National System of Social Participation (NSSP) and took other measures with the suggestion of its expansion into the legislative and judiciary powers as a way to legitimize the Brazilian democracy, considering its current stage. In conclusion, it is presented the idea expressed by the most influential and modern pedagogical trends for the creation of a participatory, solidary, non-hierarchical and critical culture since the childhood stage. This idea focuses on the resolution of questions addressed to the common good, which considers the complexity and the existing pluralism in society with a view to constant knowledge update. Knowledge update is in turn dynamic and requires such action, instilling - for the future generations - the idea that the creation of a more participatory and collaborative democracy is needed to reduce social inequality as a way to legitimize and promote social welfare, with the implementation of a policy devoted to meet the minimum fundamental rights to ensure dignity to the population.

Avaliação de qualidade da unidade de diálise no Hospital Universitário Onofre Lopes - HUOL

Over the years there has been a broader definition of the term health. At the same time it was found also an evolution of the concept of health care which in turn has led to changes in the approach to delivery of health services and hence in its management. In this regard, currently the nephrology services have been searching for quality technical and social need. In view of these innovations and the quest for quality, it elaborated the general objective: to develop a quality assessment protocol for dialysis service Onofre Lopes University Hospital. It is an intervention project effected through an action research, which consisted of 4 steps. Initially was identified through a literature search in scientific literature, which quality indicators would apply to a dialysis unit being selected as follows: infection rate in hemodialysis access site, microbiological control of water used for hemodialysis and Index User satisfaction. Through critical reflection on the theme researched in the previous step, it was drawn up three data collection instruments, interview form type, applied between the months of October and November 2015. In addition to the information obtained, also made up of the use of information retrieval technique. The results were organized in graphs and tables and analyzed using qualitative and exploratory technical approach. Then a reflective analysis of the data obtained and the diagnosis of reality studied was traced and confronted with the literature was performed. The data produced in this study revealed that the Dialysis Unit of HUOL is much to be desired, considering that some weaknesses have been identified in its structure. Faced with this finding have been proposed, as a contribution and aiming to guide the development of future actions, suggestions for improvement that should be implemented and monitored to be assured overcoming these difficulties, allowing an appropriate organizational restructuring, and resulting in improved service public offered. It was concluded that for hemodialysis treatment results are achieved and positive, it is necessary to have physical structure and adequate infrastructure, multidisciplinary team specialized, trained and in sufficient quantity, well designed processes for professionals to have standards to be followed decreasing the chance to err, and a risk management system to detect and control situations that endanger patient safety.