Oportunidades de mejora del servicio de metadona en atención primaria, desde el punto de vista profesional

Objective: To identify and prioritize improvement opportunities, according to the European Foundation for Quality Management model (EFQM) model, of the methadone dispensing service in Andalusian Primary Health Care, from the point of view of professionals. Method: Delphi consensus method, implemented from September 2007 to March 2008 by means of three rounds of interviews with questionnaires administered by electronic mail to 39 professionals. The Panel of experts was made up of Dispensers and Prescribers of methadone as well as Coordinators of welfare services from the Methadone Treatment Program (MTP). Selection criteria were: Being in active employment with a minimum of 3 years experience. Sample diversification variables: Professional role, geographical environment and type of habitat. Recruitment: By means of key professional bodies from different institutions. Results: 48 improvement opportunities were identified. Thirteen of these obtained a high level of agreement in the final round. According to the EFQM model, the dimensions that obtained the most consensus in relation to improving the care service were: Leadership, Alliances and Resources. The dimension that caused the greatest disagreement was Processes. Conclusions: In spite of its having been implemented since 1997 in Andalusian Primary Health Care, the methadone dispensing service is at an implementation phase, rather than what could be classed as a fully deployed stage

Redefinición de indicadores y planificación del proceso de recogida de datos de la Biblioteca Virtual de la Universitat Oberta de Catalunya

Pre-print.

The STOP the Bleeding Campaign.

According to the World Health Organization, traumatic injuries worldwide are responsible for over 5 million deaths annually. Post-traumatic bleeding caused by traumatic injury-associated coagulopathy is the leading cause of potentially preventable death among trauma patients. Despite these facts, awareness of this problem is insufficient and treatment options are often unclear. The STOP the Bleeding Campaign therefore aims to increase awareness of the phenomenon of post-traumatic coagulopathy and its appropriate management by publishing European guidelines for the management of the bleeding trauma patient, by promoting and monitoring the implementation of these guidelines and by preparing promotional and educational material, organising activities and developing health quality management tools. The campaign aims to reduce the number of patients who die within 24 hours after arrival in the hospital due to exsanguination by a minimum of 20% within the next 5 years.

Appropriateness of colonoscopy in Europe (EPAGE II): presentation of methodology, general results, and analysis of complications.

BACKGROUND AND STUDY AIMS: Appropriate use of colonoscopy is a key component of quality management in gastrointestinal endoscopy. In an update of a 1998 publication, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE II) defined appropriateness criteria for various colonoscopy indications. This introductory paper therefore deals with methodology, general appropriateness, and a review of colonoscopy complications. METHODS:The RAND/UCLA Appropriateness Method was used to evaluate the appropriateness of various diagnostic colonoscopy indications, with 14 multidisciplinary experts using a scale from 1 (extremely inappropriate) to 9 (extremely appropriate). Evidence reported in a comprehensive updated literature review was used for these decisions. Consolidation of the ratings into three appropriateness categories (appropriate, uncertain, inappropriate) was based on the median and the heterogeneity of the votes. The experts then met to discuss areas of disagreement in the light of existing evidence, followed by a second rating round, with a subsequent third voting round on necessity criteria, using much more stringent criteria (i. e. colonoscopy is deemed mandatory). RESULTS: Overall, 463 indications were rated, with 55 %, 16 % and 29 % of them being judged appropriate, uncertain and inappropriate, respectively. Perforation and hemorrhage rates, as reported in 39 studies, were in general < 0.1 % and < 0.3 %, respectively CONCLUSIONS: The updated EPAGE II criteria constitute an aid to clinical decision-making but should in no way replace individual judgment. Detailed panel results are freely available on the internet (www.epage.ch) and will thus constitute a reference source of information for clinicians.

A influência dos líderes no processo de mudança organizacional: um estudo de caso

Esta dissertação tem por objectivo avaliar a eficácia do processo de mudança organizacional, através das acções dos líderes, da empresa que lidera o mercado de telecomunicações em Cabo Verde, que foi objecto de um processo de reestruturação, que consistiu essencialmente na implementação de um Sistema de Gestão da Qualidade (SGQ). A implementação do referido sistema é entendida, nesta dissertação, como um modelo de mudança organizacional. Para atingir os objectivos preconizados, foi realizado um estudo de caso que contempla uma análise qualitativa dos documentos da empresa e de dados recolhidos através de entrevistas realizadas no período compreendido entre Fevereiro e Agosto de 2010. O estudo procurou compreender o contributo das práticas de liderança para a eficácia da gestão da qualidade. Nesta perspectiva, importa salientar que o tipo de liderança identificado neste estudo de caso é a liderança transformacional, que tecnicamente é o adequado quando se pretende implementar mudanças profundas e que implicam uma redefinição da missão, visão e valores da organização. Importa referir ainda que vários estudos empíricos têm demonstrado de forma consistente, uma relação positiva entre a liderança transformacional e os indicadores de eficiência no trabalho. Procurou-se entender ainda se os líderes na condução do processo de mudança organizacional da empresa estudada, seguiram o modelo proposto por John P. Kotter para a implementação eficaz de mudanças nas organizações, comparando os oito passos propostos pelo autor com os ocorridos na empresa. A avaliação deste estudo de caso permitiu concluir que a essência do modelo foi aplicado. This paper intended to assess the effectiveness of the process of organizational change, through the actions of the leaders of the company that leads the telecommunications market in Cape Verde, which was involved in a restructuration process, covering mainly the implementation of a Quality Management System (QMS). The implementation of this system is understood in this case, as a model of organizational change. To achieve the proposed goals, we performed a case study based on a qualitative analysis of corporate documents and data collected through interviews conducted between February 2010 and August 2010. This study tried to understand the role of leadership practices for the effectiveness of the quality management. In this perspective, it should be noted that the type of leadership identified in this case study is the transformational one, which, technically, is the appropriate when trying to implement significant change, which imply a redefinition of the mission, vision and values of the organization. It should be noted also that several empirical studies have consistently demonstrated a positive relationship between transformational leadership and the performance indicators in the workplace. We also tried to understand if the leaders, in driving the process of organizational change in the company studied, followed the model proposed by John P. Kotter for implementing effective change in organizations, by comparing the eight steps proposed by the author with those verified in the company. The assessment of this case study allowed us to conclude that the essence of the model is applicable to this case.

Integrated Materials and Construction Practice for Concrete Pavement: A State-of-the-Practice Manual, 2006

At the heart of all concrete pavement projects is the concrete itself. This manual is intended as both a training tool and a reference to help concrete paving engineers, quality control personnel, specifiers, contractors, suppliers, technicians, and tradespeople bridge the gap between recent research and practice regarding optimizing the performance of concrete for pavements. Specifically, it will help readers do the following:

O Processo de Implementação do Sistema de Gestão da Qualidade nas Organizações - Caso Alucar, S.A.

O presente trabalho de investigação visa explorar o “Sistema de Gestão da Qualidade” e evidenciar os procedimentos e técnicas que regem a sua implementação nas Organizações, surgindo como modelo, nesse estudo, o caso da Empresa de Aluguer de Automóveis, - ALUCAR, S.A. A nossa decisão de alvitrar a implementação desse sistema advém do conhecimento das mais-valias que esse precioso instrumento de gestão vai proporcionar à referida Organização assim como à sociedade em geral. Ao longo do trabalho, fazemos uma descrição do processo evolutivo da Qualidade, referimo-nos às suas definições, dimensões, custos e principais mentores. Na parte da Gestão da Qualidade Total, abordamos aspectos das organizações ISO e EFQM e depois reflectimos sobre a situação da Qualidade em Cabo Verde. Posteriormente, fazemos uma caracterização da Empresa em estudo, indicamos os trabalhos preliminares que devem ser levados a cabo num projecto do tipo, apresentamos as fases do processo de implementação do sistema, uma proposta de um Manual da Qualidade e, por último, as limitações e conclusões do trabalho. Durante o desenvolvimento do tema, respondemos às perguntas de partida e, opinamos sobre os objectivos gerais e específicos indicados no nosso projecto. Estamos em crer que, se o sistema em apreço for implementado na Empresa seguindo todos os passos recomendados no estudo, e havendo um forte envolvimento da gestão de topo em todo o processo, por certo que os objectivos preconizados serão atingidos. A implementação do SGQ e a certificação de uma empresa são tidas como robustos alicerces para a continuidade saudável da empresa, tendo em conta o meio envolvente cada vez mais exigente, competitivo, globalizado e globalizante. This investigative work intends to explore the “Quality Management System” and enhances the procedures and techniques that rule its implementation on Organizations, using as model in the present study, ALUCAR, S.A., a rent-a-car company. Our decision to implement this system is due to the fact that it is widely accepted that such realization brings advantages not only to clients, but also to the Organization and to society as a whole. Throughout this work, we will describe the processes of development of the quest for quality in companies, its definitions, dimensions, costs and main mentors, in the branch of the Total Quality Management; we approach aspects of such organizations as ISO and EFQM, and later depict the quality implement situation in Cape Verde. Posterior to that, we characterize the company ALUCAR, S.A., and indicate the preliminary works that ought to be taken into account when implementing quality management, present phases of such accomplishment, a proposal for a Quality Manual and, lastly, the limitations of this study, and the conclusions we have derived from such analysis. While developing the themes related to quality, we provide answers to our research questions, and indicate our general and specific objectives. It is our firm conviction that if the system here appraised is implemented in the mentioned company, following all recommended steps and with a strong involvement of management responsibles, all through the process, surely the objectives praised will be achieved. The implementation of the SGQ system and the certification of a company are two very important steps for a healthy development, knowing that the business milieu is becoming ever more demanding, competitive, globalized and globalizing.

Project AWARE 2006 Iowa River, 2007

This monthly report from the Iowa Department of Transportation is about the water quality management of Iowa's rivers, streams and lakes.

Intensive Watershed Investigations at Iowa Beaches, 2005

This monthly report from the Iowa Department of Transportation is about the water quality management of Iowa's rivers, streams and lakes.

Year 5 Accomplishments, 2005

This monthly report from the Iowa Department of Transportation is about the water quality management of Iowa's rivers, streams and lakes.

Cyanobacteria in Iowa Waters, 2005

This monthly report from the Iowa Department of Transportation is about the water quality management of Iowa's rivers, streams and lakes.

Iowa's Beach Monitoring Program, 2005

This monthly report from the Iowa Department of Transportation is about the water quality management of Iowa's rivers, streams and lakes.

Iowa's Wetland Monitoring Program, 2005

This monthly report from the Iowa Department of Transportation is about the water quality management of Iowa's rivers, streams and lakes.

Nutrient Monitoring in the Cedar Rapids Wastershed, 2004

This monthly report from the Iowa Department of Transportation is about the water quality management of Iowa's rivers, streams and lakes.

Snapshot Events, 2005

This monthly report from the Iowa Department of Transportation is about the water quality management of Iowa's rivers, streams and lakes.