Métodos de custeio no setor público: Um estudo sobre como as informações de custos atendem aos diversos stakeholders de um hospital universitário público

O setor de saúde pública convive com uma constante escassez de recursos combinada com uma necessidade crescente de investimentos em tecnologia e inovação. Portanto, é necessário que os gestores públicos de saúde busquem maneiras de maximizar o uso destes recursos orçamentários escassos. Uma das alternativas é implementar estudos sobre custos, que possibilitem ao gestor exercer o controle, o combate ao desperdício e o planejamento dos investimentos futuros. No entanto, na área governamental, existem outros grupos, além do gestor, que têm interesse em conhecer as informações de custos do setor de saúde. Esses grupos são chamados pela teoria da administração de Stakeholders. Cada stakeholder, tais como médicos, pacientes, fornecedores, sociedade entre outros podem demandar informações distintas de custos. Por este motivo, o objetivo deste trabalho é investigar qual o método de custeio que melhor se adequa as necessidades dos diferentes stakeholders de um hospital público. Para tanto, elaborou-se uma pesquisa bibliográfica que abordasse os métodos de custeio por absorção, custeio variável e custeio baseado em atividades, que são os métodos mais debatidos pela literatura contábil. Dessa forma, com objetivo de responder a questão de pesquisa, o presente trabalho desenvolve um cenário hipotético de um hospital universitário público, no qual estão identificados os seus stakeholders e suas respectivas necessidades de informações de custo. Como resultado das análises, observa-se que cada um destes stakeholders apresenta um método de custeio, ou uma combinação de dois destes, que melhor se adequa as suas necessidades de informação de custos.

A marine biogeographic assessment of the northwestern Hawaiian Islands

The mission of NOAA’s Office of National Marine Sanctuaries (ONMS) is to serve as the trustee for a system of marine protected areas, to conserve, protect and enhance biodiversity. To assist in accomplishing this mission, the ONMS has developed a partnership with NOAA’s Center for Coastal Monitoring and Assessment’s Biogeography Branch (CCMA-BB) to conduct biogeographic assessments of marine resources within and adjacent to the marine waters of NOAA’s National Marine Sanctuaries (Kendall and Monaco, 2003). Biogeography is the study of spatial and temporal distributions of organisms, their associated habitats, and the historical and biological factors that influence species’ distributions. Biogeography provides a framework to integrate species distributions and life history data with information on the habitats of a region to characterize and assess living marine resources within a sanctuary. The biogeographic data are integrated in a Geographical Information System (GIS) to enable visualization of species’ spatial and temporal patterns, and to predict changes in abundance that may result from a variety of natural and anthropogenic perturbations or management strategies (Monaco et al., 2005; Battista and Monaco, 2004). Defining biogeographic patterns of living marine resources found throughout the Northwestern Hawaiian Islands (NWHI) was identified as a priority activity at a May 2003 workshop designed to outline scientifi c and management information needs for the NWHI (Alexander et al., 2004). NOAA’s Biogeography Branch and the Papahanaumokuakea Marine National Monument (PMNM) under the direction of the ONMS designed and implemented this biogeographic assessment to directly support the research and management needs of the PMNM by providing a suite of spatially-articulated products in map and tabular formats. The major fi ndings of the biogeographic assessment are organized by chapter and listed below.

Coral reef ecosystems of Reserva Natural de La Parguera (Puerto Rico): spatial and temporal patterns in fish and benthic communities (2001-2007)

Since 1999, NOAA’s Center for Coastal Monitoring and Assessment, Biogeography Branch (CCMA-BB) has been working with federal and territorial partners to characterize monitor and assess the status of the marine environment in southwestern Puerto Rico. This effort is part of the broader NOAA Coral Reef Conservation Program’s (CRCP) National Coral Reef Ecosystem Monitoring Program (NCREMP). With support from CRCP’s NCREMP, CCMA conducts the “Caribbean Coral Reef Ecosystem Monitoring project” (CREM) with goals to: (1) spatially characterize and monitor the distribution, abundance and size of marine fauna associated with shallow water coral reef seascapes (mosaics of coral reefs, seagrasses, sand and mangroves); (2) relate this information to in situ fine-scale habitat data and the spatial distribution and diversity of habitat types using benthic habitat maps; (3) use this information to establish the knowledge base necessary for enacting management decisions in a spatial setting; (4) establish the efficacy of those management decisions; and (5) develop data collection and data management protocols. The monitoring effort of the La Parguera region in southwestern Puerto Rico was conducted through partnerships with the University of Puerto Rico (UPR) and the Puerto Rico Department of Natural and Environmental Resources (DNER). Project funding was primarily provided by NOAA CRCP and CCMA. In recent decades, scientific and non-scientific observations have indicated that the structure and function of the coral reef ecosystem in the La Parguera region have been adversely impacted by a wide range of environmental stressors. The major stressors have included the mass Diadema die off in the early 1980s, a suite of hurricanes, overfishing, mass mortality of Acropora corals due to disease and several coral bleaching events, with the most severe mass bleaching episode in 2005. The area is also an important recreational resource supporting boating, snorkeling, diving and other water based activities. With so many potential threats to the marine ecosystem several activities are underway or have been implemented to manage the marine resources. These efforts have been supported by the CREM project by identifying marine fauna and their spatial distributions and temporal dynamics. This provides ecologically meaningful data to assess ecosystem condition, support decision making in spatial planning (including the evaluation of efficacy of current management strategies) and determine future information needs. The ultimate goal of the work is to better understand the coral reef ecosystems and to provide information toward protecting and enhancing coral reef ecosystems for the benefit of the system itself and to sustain the many goods and services that it offers society. This Technical Memorandum contains analysis of the first seven years of fish survey data (2001-2007) and associated characterization of the benthos. The primary objectives were to quantify changes in fish species and assemblage diversity, abundance, biomass and size structure and to provide spatially explicit information on the distribution of key species or groups of species and to compare community structure across the seascape including fringing mangroves, inner, middle, and outer reef areas, and open ocean shelf bank areas.

MUES (Mid Wales - Users - Ethnic Services) Ethnic services provision 2007-08. Report for Libraries for Life: Delivering the entitlement agenda for library users in Wales 2007-09

Thomas, R., Urquhart, C., Crossan, S. & Hines, B. (2008). MUES (Mid Wales - Users - Ethnic Services) Ethnic services provision 2007-08. Report for Libraries for Life: Delivering the entitlement agenda for library users in Wales 2007-09. Aberystwyth: Department of Information Studies, Aberystwyth University. Related policy guidance published separately Sponsorship: CyMAL

Real-time decision aid display

Gemstone Team Future Firefighting Advancements

Las bibliotecas rurales en los medios de comunicación de la Región de Extremadura: un estudio de caso

El objetivo principal de este trabajo es, a través de las noticias publicadas en diversos medios de comunicación de la Región de Extremadura sobre bibliotecas rurales a lo largo de los últimos años, comprobar el impacto y la visibilidad de las bibliotecas en los medios. Para ello, se recopilan un total de 1196 noticias que, tras ser analizadas detalladamente, se reducen a 300 sobre las que versan los resultados del estudio. Esta disminución de noticias finales demuestra que el titular o los primeros párrafos no expresan exactamente el contenido de la noticia siendo necesario un análisis cualitativo de su contenido. Se concluye que: las noticias sobre bibliotecas rurales han decrecido en el periodo analizado (2007, 2008, 2012, 2013), siendo 2007 el año de mayor auge, si bien se ha observado un repunte en 2013 con respecto a 2012; las noticias sobre bibliotecas rurales de ámbito provincial (Badajoz y Cáceres) obtienen mayor porcentaje que las regionales y nacionales (sin representación); y el diario HOY es, con diferencia, el medio que acumula el mayor porcentaje de noticias sobre bibliotecas rurales.

La existencia de necesidades de información y comportamiento informativo en los entrenadores en deportes de combate

Este trabajo tiene como propósito esencial, realizar un acercamiento para detectar e identificar las necesidades de información y el comportamiento informativo de entrenadores en deportes de combate. Para ello se aplicó un cuestionario a instructores de aikido, boxeo, esgrima, judo, karate, kendo, lima lama, lucha y taekwondo seleccionados mediante un muestreo no probabilístico por causalidad. En general encontramos que los principales temas de interés entre los instructores son: los programas de entrenamiento, nutrición y dietas de entrenamiento. Por otra parte, los entrenadores son más propensos a utilizar su experiencia, internet y cursos para obtener información. En contraste se nota que la biblioteca y los libros son poco usados.

Using the opinions of coronary heart disease patients in designing a health education booklet for use in general practice consultations.

Objective This study explored how coronary heart disease (CHD) patients’ views would inform the design of an information booklet aimed at providing patients and practitioners with a resource to help influence positively patients’ health behaviour outcomes. Methods Opinions of patients (N=23) with CHD about their information needs, particularly lifestyle advice, were explored using a qualitative approach in four general practices. This information was used in designing a booklet for a pilot study intervention aimed at promoting healthy lifestyle behaviours and medication adherence among people with CHD. Subsequent focus groups explored patients’ (N=17) opinions about the booklet’s ‘fitness for purpose’; semi-structured interviews with practitioners (N=10) examined their views on the booklet’s usefulness. Results In initial focus groups patients identified gaps in their information provision regarding coping with stress, available local community support and medication purpose. A booklet, prepared on the basis of previous literature, was modified to address these gaps. Pilot study patients were satisfied with the re-designed booklet and practitioners reported that its use in consultations enabled change implementation and facilitated patients’ understanding of connections between lifestyle and health outcomes. Conclusion Acknowledging the opinions of CHD patients in producing health information booklets which emphasised a patient centred approach supported practitioner-patient partnerships for choosing healthy lifestyle choices.

Environmental Value Added - Ein neues Maß zur Messung der Öko-Effizienz. (Environmental Value Added. A new measure for the measurement of eco-efficiency)

To increase eco-efficiency environmental information needs to be integrated into corporate decision making. For decision makers the interpretation of eco-efficiency as a ratio can however be quite difficult in practice. One of the reasons for this is, that eco-efficiency as a ratio is measured in a unit, that is difficult to interpret. This article therefore suggests an alternative measure for eco-efficiency. The Environmental Value Added, the measure proposed in this paper, reflects the excess economic benefit, resulting from the difference between the eco-efficiency under consideration and a benchmark eco-efficiency. It is measured in a purely monetary unit and is thus easier to interpret and integrate than eco-efficiency as a ratio.

Teaching family carers about home based palliative care: Final results from a group education program

Without the considerable support provided by family carers, many patients receiving palliative care would be unable to remain at home. However, family carers typically lack the required information and skills to prepare them for such a role. Pilot work has demonstrated that group education programs for family carers can be readily developed; they are feasible, accessible, and useful. This project sought to build on our pilot research to further examine the effectiveness of a group education program by evaluating the outcomes with a larger number of participants. The program aimed to prepare primary family carers for the role of supporting a relative with advanced, noncurative cancer at home. The psycho-educational program consisted of three consecutive weekly sessions presented in a group format, conducted at six home-based palliative care services across metropolitan and regional Victoria, Australia. The following dependent variables were measured at three time points: carer competence, preparedness, rewards, and information needs. The three time points were: commencement of the program (Time 1), upon completion (Time 2), and two weeks later (Time 3). A total of 156 participants (including the pilot phase) completed Time 1 questionnaires and 96 completed all three time periods (62%). Between Time 1 and Time 2, the intervention had a statistically significant positive effect on preparedness, competence, rewards, and having informational needs met. Outcomes were maintained at Time 3. There was no difference in the effectiveness of the intervention for participants in regional areas compared to participants in metropolitan areas.

This study demonstrated that a group education program to prepare family carers for the role of supporting a dying relative at home was effective. Implications for further research and practice are outlined.

Experiences of carers supporting dying renal patients managed without dialysis

Aim: To explore the impact of being a family carer to patients with stage 5 chronic kidney disease managed without dialysis.
Background: Increasing numbers of patients with renal disease worldwide are making the decision not to embark on dialysis. This group has significant physical and psychological symptom burdens similar to or greater than those in advanced cancer patients. Little is known about the impact on family carers.
Design: Exploratory, qualitative design.
Methods: The study was undertaken with 19 carers caring for patients managed in a Renal Supportive Care Service in the UK between 2006–2008. Sixty-one semi-structured interviews and detailed field notes inform the analysis.
Findings: ‘Caring from diagnosis to death’ was the overarching theme illustrated by three sub-themes: (i) Caregiver's plight – making sense of the disease and potential deterioration; (ii) Having to care indefinitely; and (iii) Avoiding talk of death. ‘Caring from diagnosis to death’ coincides with an original concept analysis of renal supportive care, which is considered an adjunct to the management of patients with renal disease at all stages of their illness.
Conclusion: There is a clear need for further research internationally and theory-based nursing interventions to support carers of patients managed without dialysis. The development of a holistic, integrated care pathway based on carer perspectives, which includes identification of information needs related to original diagnosis, associated comorbidities, treatment options, prognosis, and assistance in developing strategies to manage communication with patients as the end of life approaches, is required.

Identifying research priorities in long term care homes

Concerns about the quality of care in long term care (LTC) homes range from inadequate daily care to understaffing and insufficient funding. LTC decision makers are challenged to keep up with the changing demographics of residents admitted to LTC who have increasingly complex care needs. Decisions regarding LTC policies and procedures need to be informed by research that identifies the most effective and efficient care practices.This study solicited feedback from LTC decision makers in Ontario, Canada, regarding research priorities to guide improvement in the quality of care in LTC homes. Representatives from 134 LTC homes responded (53.6% response rate). Nine thematic areas of research were identified: delivery of care; staffing; organization and structure of homes; funding; indicators, standards, policies, and procedures; managing difficult behaviors; education; safety; and infectious disease control. It is anticipated that these themes will steer research down a path that is responsive to the information needs of practitioners in LTC homes. © 2012 American Medical Directors Association, Inc.

Charity accountability in the UK: through the eyes of the donor

Purpose – The purpose of this paper is to explore accountability from the perspective of charity donors.

Design/methodology/approach – The research utilises semi-structured interviews with a range of donors. In addition, it summarises the main findings from key related research (that uses document content analysis and questionnaire surveys) as a basis for better appreciating donor engagement.

Findings – This research offers evidence that while donors are viewed as the key stakeholder to whom a charity should be accountable, the relevance of the information commonly disclosed in formal charity communications is questionable. This is viewed as significant in terms of small dependent donors, although less critical in the case of non-dependent large donors who have power to demand individualised information. However, although all donors do not particularly engage with these formal communications, they are viewed by them as having significance and their production and publication serves as an important legitimising tool in the sector (enhancing trust and reputation).

Research limitations/implications – This research is based on semi-structured interviews with individual small donors and large institutional donors to large UK charities and therefore any generalising of the conclusions beyond large charities, and beyond the UK, should be undertaken with care. In addition, it focuses solely on the perceptions of donors, and other stakeholder groups are also important in this process.

Originality/value – Despite the widespread acceptance that charities have a duty to discharge accountability to their stakeholders, there is limited knowledge of their information needs and whether the performance information currently being disclosed fulfils them. This study provides a unique insight into the perspective of a key stakeholder group (donors) with respect to accountability.

Psychosocial, educational and communicative interventions for patients with cachexia and their family carers

Purpose of review: Cancer cachexia has a substantial impact on both patients and their family carers. It has been acknowledged as one of the two most frequent and devastating problems of advanced cancer. The impact of cachexia spans biopsychosocial realms. Symptom management in cachexia is fraught with difficulties and globally, there remains no agreed standard care or treatment for this client group. There is a need to address the psychosocial impact of cachexia for both patients and their family carers.

Recent findings: Patients living at home and their family carers are often left to manage the distressing psychosocial impacts of cancer cachexia themselves. Successful symptom management requires healthcare professionals to address the holistic impact of cancer cachexia. High quality and rigorous research details the existential impact of cachexia on patients and their family carers. This information needs to inform psychosocial, educational and communicative supportive healthcare interventions to help both patients and their family carers better cope with the effects of cachexia.

Summary: Supportive interventions need to inform both patients and their family carers of the expected impacts of cachexia, and address how to cope with them to retain a functional, supported family unit who are informed about and equipped to care for a loved one with cachexia.

Women’s Perceptions and Experiences of Fetal Macrosomia

Objective
to explore women's perceptions and experiences of pregnancy and childbirth following birth of a macrosomic infant (birth weight ≥4000 g).

Methods
a qualitative design utilising interviews conducted 13–19 weeks post partum in women's homes. The study was conducted in one Health and Social Care Trust in Northern Ireland between January and September 2010. Participants were identified from a larger cohort of women recruited to a prospective study exploring the impact of physical activity and nutrition on macrosomia. Eleven women who delivered macrosomic infants participated in this phase of the study.

Findings
four overarching themes emerged: preparation for delivery; physical and emotional impact of macrosomia; professional relations and perceptions of macrosomia. Findings highlighted the importance of communication with health professionals in relation to both prediction of macrosomia and decision making about childbirth, and offers further understanding into the physical and emotional impact of having a macrosomic infant on women. Furthermore, there was evidence that beliefs and perceptions relating to macrosomia may influence birth experiences and uptake of health promotion messages.

Key conclusions and implications for practice
this study provides important insight into women's experiences of macrosomia throughout the perinatal period and how they were influenced by previous birth experiences, professional relations and personal perceptions and beliefs about macrosomia. Pregnant women at risk of having a macrosomic infant may require extra support throughout the antenatal period continuing into the postnatal period. Support needs to be tailored to the woman's information needs, with time allocated to explore previous birth experiences, beliefs about macrosomia and options for childbirth.