Introdução da linguagem CIPE na Maternidade Dr. Francisco Feitinha nos focos gravidez, trabalho de parto e parto

Os sistemas de informação têm cada vez mais importância nos serviços de saúde. Sistemas de informação eficientes, permitem a maximização da gestão dos serviços promovendo a melhoria da qualidade dos cuidados. A ordem dos enfermeiros sugere a implementação de sistemas de registos que englobem necessidades de cuidados, intervenções de enfermagem e resultados dessas mesmas intervenções. A associação portuguesa de enfermeiros faz referência à importância de uma linguagem comum entre os enfermeiros. A linguagem CIPE® “é uma classificação de fenómenos, intervenções e resultados a nível da enfermagem. Pretende ser uma matriz unificadora em que as taxonomias e classificações de enfermagem já existentes se possam entrecruzar, de modo a permitir comparar dados em enfermagem” (CIE,2000:11) A adaptação da linguagem CIPE à gravidez, trabalho de parto e parto, é uma mais-valia no que concerne á realização de registos de qualidade que permitam uma linguagem comum, abrangente e facilitadora da comunicação entre os enfermeiros, e entre estes e outros profissionais de saúde. Através da consulta de bibliografia, dos manuais CIPE® disponíveis, de documentos existentes no serviço, dos processos clínicos e pelos conhecimentos adquiridos durante a especialização de enfermagem de saúde materna e obstetrícia, foi feito o levantamento dos fenómenos, diagnósticos e intervenções de enfermagem em relação aos focos gravidez, trabalho de parto e parto, para futura introdução no sistema informático, tendo em conta as actividades mais frequentes na maternidade para estes focos. A definição de uma Linguagem uniforme a ser utilizada por todos os enfermeiros do serviço, levou a um esforço conjunto da equipa de enfermagem e chefia. Este trabalho continua em curso, uma vez que as actividades que se realizam na maternidade têm que ser todas parametrizadas, o que torna o trabalho de parametrização um pouco mais moroso. Os dados só serão introduzidos no sistema depois da parametrização de todas actividades do serviço. Após a introdução dos dados no sistema informático e da linguagem CIPE perfeitamente adaptada à realidade da maternidade, é nossa convicção que a economia de tempo e a desburocratização dos registos libertará os profissionais para uma relação enfermeiro/utente que se pretende mais humana.

Pricing recreation use of national parks for an efficient nature conservation : an application to the portuguese case

Current institutions, research, and legislation have not yet been sufficient to achieve the conservation level of Nature as required by the society. One of the reasons that explains this relative failure is the lack of incentives to motivate local individual and Nature users in general, to adopt behaviour compliant with Nature sustainable uses. Economists believe that, from the welfare point of view, pricing is the more efficient way to make economic actors to take more environmental friendly decisions. In this paper we will discuss how efficient can be the act of pricing the recreation use of a specific natural area, in terms of maximising welfare. The main conservation issues for pricing recreation use, as well as the conditions under which pricing will be an efficient and fair instrument for the natural area will be outlined. We will conclude two things. Firstly that, from the rational utilitarian economic behaviour point of view, economic efficiency can only be achieved if the natural area has positive and known recreation marginal costs under the relevant range of the marshallian demand recreation curve and if price system management is not costly. Secondly, in order to guarantee equity for the different type of visitors when charging the fee, it is necessary to discuss differential price systems. We shall see that even if marginal recreation costs exist but are unknown, pricing recreation is still an equity instrument and a useful one from the conservation perspective, as we shall demonstrate through an empirical application to the Portuguese National Park. An individual Travel Cost Method Approach will be used to estimate the recreation price that will be set equal to the visitor’s marginal willingness to pay for a day of visit in the national park. Although not efficient, under certain conditions this can be considered a fair pricing practice, because some of the negative recreation externalities will be internalised. We shall discuss the conditions that guarantee equity on charging for the Portuguese case.

Functional defict and sensitive outcomes to nursing care for elderly: Systematic literature review.

ABSTRACT Objective of this study was to determine sensitive outcomes to nursing care in relation to the functional deficit of people aged 65 and older. It is a Systematic Literature Review with qualitative synthesis and meta-analysis. From the qualitative synthesis, it was found that sensitive outcomes to nursing care, observed from structured intervention, were described as improvement of: functional status, self-care, symptom control, safety/adverse events, customer satisfaction, psychological support, decreased healthcare costs, therapeutic system management and quality of life. In meta-analysis we found that there is an improvement of effect on the level of sensitive outcomes to the nursing care between the experimental and control groups. It is noticed that it is necessary to rouse more guided study in clinical practice, to understand the importance of interventions sensitive to nursing care and health outcomes.

Commonalities between networking in multiplayer computer games and negotiation processes in a future multi-layered Air Traffic Management (ATM) system

First, this paper describes a future layered Air Traffic Management (ATM) system centred in the execution phase of flights. The layered ATM model is based on the work currently performed by SESAR [1] and takes into account the availability of accurate and updated flight information ?seen by all? across the European airspace. This shared information of each flight will be referred as Reference Business Trajectory (RBT). In the layered ATM system, exchanges of information will involve several actors (human or automatic), which will have varying time horizons, areas of responsibility and tasks. Second, the paper will identify the need to define the negotiation processes required to agree revisions to the RBT in the layered ATM system. Third, the final objective of the paper is to bring to the attention of researchers and engineers the communalities between multi-player games and Collaborative Decision Making processes (CDM) in a layered ATM system

A decision support system to facilitate management of patients with acute gastrointestinal bleeding

Objective: To develop a model to predict the bleeding source and identify the cohort amongst patients with acute gastrointestinal bleeding (GIB) who require urgent intervention, including endoscopy. Patients with acute GIB, an unpredictable event, are most commonly evaluated and managed by non-gastroenterologists. Rapid and consistently reliable risk stratification of patients with acute GIB for urgent endoscopy may potentially improve outcomes amongst such patients by targeting scarce health-care resources to those who need it the most. Design and methods: Using ICD-9 codes for acute GIB, 189 patients with acute GIB and all. available data variables required to develop and test models were identified from a hospital medical records database. Data on 122 patients was utilized for development of the model and on 67 patients utilized to perform comparative analysis of the models. Clinical data such as presenting signs and symptoms, demographic data, presence of co-morbidities, laboratory data and corresponding endoscopic diagnosis and outcomes were collected. Clinical data and endoscopic diagnosis collected for each patient was utilized to retrospectively ascertain optimal management for each patient. Clinical presentations and corresponding treatment was utilized as training examples. Eight mathematical models including artificial neural network (ANN), support vector machine (SVM), k-nearest neighbor, linear discriminant analysis (LDA), shrunken centroid (SC), random forest (RF), logistic regression, and boosting were trained and tested. The performance of these models was compared using standard statistical analysis and ROC curves. Results: Overall the random forest model best predicted the source, need for resuscitation, and disposition with accuracies of approximately 80% or higher (accuracy for endoscopy was greater than 75%). The area under ROC curve for RF was greater than 0.85, indicating excellent performance by the random forest model Conclusion: While most mathematical models are effective as a decision support system for evaluation and management of patients with acute GIB, in our testing, the RF model consistently demonstrated the best performance. Amongst patients presenting with acute GIB, mathematical models may facilitate the identification of the source of GIB, need for intervention and allow optimization of care and healthcare resource allocation; these however require further validation. (c) 2007 Elsevier B.V. All rights reserved.

An Intelligent Distributed System for Environmental Management

Environmental management is a complex task. The amount and heterogeneity of the data needed for an environmental decision making tool is overwhelming without adequate database systems and innovative methodologies. As far as data management, data interaction and data processing is concerned we here propose the use of a Geographical Information System (GIS) whilst for the decision making we suggest a Multi-Agent System (MAS) architecture. With the adoption of a GIS we hope to provide a complementary coexistence between heterogeneous data sets, a correct data structure, a good storage capacity and a friendly user’s interface. By choosing a distributed architecture such as a Multi-Agent System, where each agent is a semi-autonomous Expert System with the necessary skills to cooperate with the others in order to solve a given task, we hope to ensure a dynamic problem decomposition and to achieve a better performance compared with standard monolithical architectures. Finally, and in view of the partial, imprecise, and ever changing character of information available for decision making, Belief Revision capabilities are added to the system. Our aim is to present and discuss an intelligent environmental management system capable of suggesting the more appropriate land-use actions based on the existing spatial and non-spatial constraints.

Development and implementation of an integrated technical management system

Quality Management, Integrated Technical Management Systems, ITMS, Technical Elements, Environment, Occupational Health and safety, OH&S, Standards, ISO, General Regulations, Integration, Management Functions, Computer Centre, Suc-cess Concepts, Documentation, PCT, QMS, EMS, OH&S-MS, Portioning, Evaluation, Technical Cycle, Technical Compliance, Framework

Dynamic bandwidth management as part of an integrated network management system based on distributed agents

We present a system for dynamic network resource configuration in environments with bandwidth reservation and path restoration mechanisms. Our focus is on the dynamic bandwidth management results, although the main goal of the system is the integration of the different mechanisms that manage the reserved paths (bandwidth, restoration, and spare capacity planning). The objective is to avoid conflicts between these mechanisms. The system is able to dynamically manage a logical network such as a virtual path network in ATM or a label switch path network in MPLS. This system has been designed to be modular in the sense that in can be activated or deactivated, and it can be applied only in a sub-network. The system design and implementation is based on a multi-agent system (MAS). We also included details of its architecture and implementation

Semantic data integration in a newspaper content management system

A newspaper content management system has to deal with a very heterogeneous information space as the experience in the Diari Segre newspaper has shown us. The greatest problem is to harmonise the different ways the involved users (journalist, archivists...) structure the newspaper information space, i.e. news, topics, headlines, etc. Our approach is based on ontology and differentiated universes of discourse (UoD). Users interact with the system and, from this interaction, integration rules are derived. These rules are based on Description Logic ontological relations for subsumption and equivalence. They relate the different UoD and produce a shared conceptualisation of the newspaper information domain.

MODELING A COMPUTER APPLICATION FOR MANAGEMENT OF MAINTENANCE ACTIVITIES OF UNPAVED ROADS

ABSTRACTThis study presents a contribution to the modeling of a computer application employing a method of serviceability performance for unpaved roads, aiming the management of maintenance/restoration activities of the primary surface layer. The proposed methodology consisted of field inspections during dry (April to September) and rainy (October to March) periods, during which objective evaluations were performed to survey of defects and their densities and degrees of severity. To aid the functional classification of analyzed road sections and the determination of the defect with major influence on the serviceability of these roads, the method of serviceability performance proposed by Silva (2009)was implemented in the Visual Basic for Applications (VBA) language in Microsoft Excel software. With the use of the computer application proposed it was possible to identify among the defects analyzed in field, through the index of serviceability of the sampling unit per defect type (ISUdef), which one had the greatest influence on determining the relative serviceability index per road section (IST). The results allow us to conclude that the computer application Road achieved satisfactory results, since the objective evaluation criteria applied to road sections denotes consistency regarding their serviceability.

The Design and Implementation of a Power Management Feature to a Configuration Management System

Green IT is a term that covers various tasks and concepts that are related to reducing the environmental impact of IT. At enterprise level, Green IT has significant potential to generate sustainable cost savings: the total amount of devices is growing and electricity prices are rising. The lifecycle of a computer can be made more environmentally sustainable using Green IT, e.g. by using energy efficient components and by implementing device power management. The challenge using power management at enterprise level is how to measure and follow-up the impact of power management policies? During the thesis a power management feature was developed to a configuration management system. The feature can be used to automatically power down and power on PCs using a pre-defined schedule and to estimate the total power usage of devices. Measurements indicate that using the feature the device power consumption can be monitored quite precisely and the power consumption can be reduced, which generates electricity cost savings and reduces the environmental impact of IT.

Management of Traffic Control — A Computer Oriented Approach

Traffic Management system (TMS) comprises four major sub systems: The Network Database Management system for information to the passengers, Transit Facility Management System for service, planning, and scheduling vehicle and crews, Congestion Management System for traffic forecasting and planning, Safety Management System concerned with safety aspects of passengers and Environment. This work has opened a rather wide frame work of model structures for application on traffic. The facets of these theories are so wide that it seems impossible to present all necessary models in this work. However it could be deduced from the study that the best Traffic Management System is that whichis realistic in all aspects is easy to understand is easy to apply As it is practically difficult to device an ideal fool—proof model, the attempt here has been to make some progress-in that direction.

Dynamic bandwidth management as part of an integrated network management system based on distributed agents

We present a system for dynamic network resource configuration in environments with bandwidth reservation and path restoration mechanisms. Our focus is on the dynamic bandwidth management results, although the main goal of the system is the integration of the different mechanisms that manage the reserved paths (bandwidth, restoration, and spare capacity planning). The objective is to avoid conflicts between these mechanisms. The system is able to dynamically manage a logical network such as a virtual path network in ATM or a label switch path network in MPLS. This system has been designed to be modular in the sense that in can be activated or deactivated, and it can be applied only in a sub-network. The system design and implementation is based on a multi-agent system (MAS). We also included details of its architecture and implementation