Healthcare- Associated infections: An analysis of costs in a Portuguese Hospital

Hospital-acquired infections (HAIs) delay healing, prolong Hospital stay, and increase both Hospital costs and risk of death. This study aims to estimate the extra length of stay and mortality rate attributable to each of the following HAIs: wound infection (WI); bloodstream infection (BSI); urinary infections (UI); and Hospital-acquired pneumonia (HAP). The study population consisted of patients discharged in CHLC in 2014. Data was collected to identify demographic information, surgical operations, development of HAIs and its outputs. The study used regressions and a matched strategy to compare cases (infected) and controls (uninfected). The matching criteria were: age, sex, week and type of admission, number of admissions, major diagnostic category and type of discharge. When compared to matched controls, cases with HAI had a higher mortality rate and greater length of stay. WI related to hip or knee surgery, increased mortality rate by 27.27% and the length of stay by 74.97 days. WI due to colorectal surgery caused an extra mortality rate of 10.69% and an excess length of stay of 20.23 days. BSI increased Hospital stay by 28.80 days and mortality rate by 32.27%. UI caused an average additional length of stay of 19.66 days and risk of death of 12.85%. HAP resulted in an extra Hospital stay of 25.06 days and mortality rate of 24.71%. This study confirms the results of the previous literature that patients experiencing HAIs incur in an excess of mortality rates and Hospital stay, and, overall, it presents worse results comparing with other countries.

Development of benchmarks for operating costs and resources consumption to be used in healthcare building sustainability assessment methods

Since the last decade of the twentieth century, the healthcare industry is paying attention to the environmental impact of their buildings and therefore new regulations, policy goals and Buildings Sustainability Assessment (HBSA) methods are being developed and implemented. At the present, healthcare is one of the most regulated industries and it is also one of the largest consumers of energy per net floor area. To assess the sustainability of healthcare buildings it is necessary to establish a set of benchmarks related with their life-cycle performance. They are both essential to rate the sustainability of a project and to support designers and other stakeholders in the process of designing and operating a sustainable building, by allowing the comparison to be made between a project and the conventional and best market practices. This research is focused on the methodology to set the benchmarks for resources consumption, waste production, operation costs and potential environmental impacts related to the operational phase of healthcare buildings. It aims at contributing to the reduction of the subjectivity found in the definition of the benchmarks used in Building Sustainability Assessment (BSA) methods, and it is applied in the Portuguese context. These benchmarks will be used in the development of a Portuguese HBSA method.

Spousal support and satisfaction with healthcare services as moderators between psychological morbidity and adherence to diet in Type 2 Diabetes patients

Objectives: This study analyzed the moderating role of partners’ support and satisfaction with healthcare services in the relationship between psychological morbidity and adherence to diet in patients with type 2 diabetes (T2DM). Methods: Participants were 387 recently diagnosed T2DM patients that answered the following instruments: Revised Summary of Diabetes Self- Care Activities Measure, Hospital Anxiety and Depression Scales, Multidimensional Diabetes Questionnaire and Patient Satisfaction Questionnaire. Results: Partners’ positive and negative support moderated the relationship between psychological morbidity and adherence to diet. Satisfaction with healthcare services also moderated the relationship between psychological morbidity and adherence to diet. Conclusions: Intervention programs to promote adherence to diet in patients with type 2 diabetes should focus on partners’ support and patient satisfaction with healthcare services.

School health promotion and teacher professional identity

PURPOSE – Health and education are inextricably linked. Health promotion sits somewhat uncomfortably within schools, often remaining a marginal aspect of teachers’ work. The purpose of this paper is to examine the compatibility of an HP-initiative with teacher professional identity. DESIGN/METHODOLOGY/APPROACH – A qualitative research design was adopted consisting of semi-structured interviews. In total, 49 teachers in two school districts in the Auvergne region in central France were interviewed in depth post having completed three years’ involvement in a health promoting schools initiative called “Learning to Live Better Together” (“Apprendre a Mieux Vivre Ensemble”). FINDINGS – Teachers in the study had a broad conceptualisation of their role in health promotion. In keeping with international trends, there was more success at classroom than at whole school level. While generally teachers can be reluctant to engage with health promotion, the teachers in this study identified having little difficulty in understanding their professional identity as health promoters and identified strong compatibility with the HP-initiative. PRACTICAL IMPLICATIONS – Teachers generally viewed professional development in health promotion in a positive light when its underlying values were commensurate with their own and when the context was seen as compatible with the school mission. The promotion of health in schools needs to be sensitive to professional identity and be tailored specifically to blend more successfully with current teacher identity and practice. ORIGINALITY/VALUE – The promotion of health in schools needs to be sensitive to professional identity and be tailored specifically to blend more successfully with current teacher identity and practice.

Satisfação profissional dos Técnicos de Diagnóstico e Terapêutica

Dissertação de mestrado em Gestão de Unidades de Saúde

Aplicação de princípios e ferramentas lean numa unidade de cirurgia de ambulatório de um hospital

Dissertação de mestrado integrado em Engenharia Industrial

All different or all the same? Exploring the diversity of professional practices in Portuguese school psychology

"Published online: 29 March 2016"

Pervasive adaptive data acquisition gateway for critical healthcare

The data acquisition process in real-time is fundamental to provide appropriate services and improve health professionals decision. In this paper a pervasive adaptive data acquisition architecture of medical devices (e.g. vital signs, ventilators and sensors) is presented. The architecture was deployed in a real context in an Intensive Care Unit. It is providing clinical data in real-time to the INTCare system. The gateway is composed by several agents able to collect a set of patients’ variables (vital signs, ventilation) across the network. The paper shows as example the ventilation acquisition process. The clients are installed in a machine near the patient bed. Then they are connected to the ventilators and the data monitored is sent to a multithreading server which using Health Level Seven protocols records the data in the database. The agents associated to gateway are able to collect, analyse, interpret and store the data in the repository. This gateway is composed by a fault tolerant system that ensures a data store in the database even if the agents are disconnected. The gateway is pervasive, universal, and interoperable and it is able to adapt to any service using streaming data.

The construction of professional identities in the contexts of work

This chapter identifies and analyzes some characteristics of working situations that are important in the construction of professional identities. It is claimed that professional identity presumes a dynamic process and is constructed and reconstructed in social situations and interactions. Work has a central place in the life of individuals and societies. The contexts of work are places par excellence for investment, expression, negotiation and recognition of the actor themselves and of others. They are, thus, situations for the attribution offeelings about work, ofrelational transactions, oflearning and production of professional know ledge, which are fundamental elements in the (re )construction of professional identity and which are emphasized here below.

Análisis crítico de la formación y capacitación del profesional de la seguridad en la Provincia de Córdoba en los últimos diez años. A critical analysis of the formation and training of the professional in the area of security in the province of Córdoba in the last 10 years.

El problema que abordaremos es la transformación y la toma de decisiones en los procesos de formación y capacitación de las instituciones de seguridad, específicamente, los motivos y fundamentos de los cambios en los planes de estudios, en relación a los contenidos curriculares de los institutos de formación de los profesionales en seguridad. Esto sobre la hipótesis de que las organizaciones educativas policiales y penitenciarias han llevado a cabo transformaciones en su organización y gestión curricular para adecuarse a las nuevas demandas sociales y políticas. El objetivo del presente proyecto es analizar críticamente los contenidos curriculares de los institutos de formación y capacitación de la Policía y Servicio Penitenciario de la Provincia de Córdoba. Abordaremos el análisis de los planes de dichas instituciones en los últimos 10 años, sus modificaciones y criterios utilizados para responder a los nuevos escenarios sociales. Se hará una exploración de la información y la documentación existente en los ámbitos oficiales. Asimismo, la investigación contará con la realización de entrevistas y encuestas a directivos, docentes, alumnos y demás actores claves, con la finalidad de recabar la opinión de los mismos respecto de las transformaciones en la educación policial y penitenciaria. A partir del proyecto de investigación se pretende construir conocimiento acerca de las políticas educativas en el área de seguridad especialmente sobre la formación y capacitación de recursos profesionales específicos, dentro del ámbito local. De tal modo, se pretende aportar elementos teóricos de análisis al modo en que se han instituido la oferta educativa y las transformaciones en los planes de estudios en las instituciones de formación profesional de la seguridad y cómo éstos han sido implementados a la luz de los nuevos escenarios políticos y sociales. Esto nos permitirá aportar al incipiente campo de los estudios sobre la seguridad, específicamente sobre la formación de los profesionales en seguridad, poniendo a diposición de los responsables gubernamentales e institucionales un estudio que explora y sistematiza las transformaciones y fundamentos de la politica de educación en el campo de la seguridad provincial. Este desarrollo investigativo nos permitirá inagurar la actividad de producción de conocimiento dentro del ámbito académico de la Licenciatura en Seguridad de la Universidad Nacional de Villa María a través del presente proyecto que describirá el proceso de formación y capacitación policial y penitenciaria y los cambios que con el transcurso del tiempo se han verificado.

Healthcare-Associated Infective Endocarditis: a Case Series in a Referral Hospital from 2006 to 2011

Background: Healthcare-associated infective endocarditis (HCA-IE), a severe complication of medical care, shows a growing incidence in literature. Objective: To evaluate epidemiology, etiology, risk factors for acquisition, complications, surgical treatment, and outcome of HCA-IE. Methods: Observational prospective case series study (2006-2011) in a public hospital in Rio de Janeiro. Results: Fifty-three patients with HCA-IE from a total of 151 cases of infective endocarditis (IE) were included. There were 26 (49%) males (mean age of 47 ± 18.7 years), 27 (51%) females (mean age of 42 ± 20.1 years). IE was acute in 37 (70%) cases and subacute in 16 (30%) cases. The mitral valve was affected in 19 (36%) patients and the aortic valve in 12 (36%); prosthetic valves were affected in 23 (43%) patients and native valves in 30 (57%). Deep intravenous access was used in 43 (81%) cases. Negative blood cultures were observed in 11 (21%) patients, Enterococcus faecalis in 10 (19%), Staphylococcus aureus in 9 (17%), and Candida sp. in 7 (13%). Fever was present in 49 (92%) patients, splenomegaly in 12 (23%), new regurgitation murmur in 31 (58%), and elevated C-reactive protein in 44/53 (83%). Echocardiograms showed major criteria in 46 (87%) patients, and 34 (64%) patients were submitted to cardiac surgery. Overall mortality was 17/53 (32%). Conclusion: In Brazil HCA-IE affected young subjects. Patients with prosthetic and native valves were affected in a similar proportion, and non-cardiac surgery was an infrequent predisposing factor, whereas intravenous access was a common one. S. aureus was significantly frequent in native valve HCA-IE, and overall mortality was high.

The Spanish cadet in the European military context a comparative analysis of the professional socialisation

Research on the attitudes, motivations and social and political behavior of European cadets have been made throughout the last decade. Nowadays Spain also joins those surveys. Thru the analysis of polling data, we can consider the different attitudes of Spanish cadets in relation with the other European ones. The conclusion is that although the Spanish political transition to democracy has not ended already in the military teaching system, there are a lot of similarities among Spanish and European cadets.

Negotiation advantages of professional associations in health care

In several instances, third-party payers negotiate prices of health care services with providers. We show that a third-party payer may prefer to deal with a professional association than with the sub-set constituted by the more efficient providers, and then apply the same price to all providers. The reason for it is the increase in the bargaining position of providers. The more efficient providers are also the ones with higher profits in the event of negotiation failure. This allows them to ext act a higher surplus from the third-party payer.