Quality Management

The purpose of this chapter is to enable registered health and social care prac - titioners to assume a clinical and/or a professional leadership role in quality management in the health and social care sectors. The contents in this chap - ter will strengthen the management competences of practitioners working in these sectors, including critical thinking, critical reflection, problem solving and decision -making, thus improving the quality in health and social care services.

Cultural Values Change in the Rehabilitation of Historic Schools in Portugal

Despite the importance of the preservation of the historic built environment for the benefit of present and future generations, there is a lack of knowledge of the effects of architectural rehabilitation decisions on the cultural significance of historic buildings. Architectural heritage conservation literature has focused almost exclusively on providing principles and guidelines, describing intervention methodologies, and discussing predicted impacts of design on material values. This thesis argues that a focus on the actual effects is needed if the sociocultural sustainability of historic buildings significance is to be achieved. Supported by an extensive literature review and informed by personal insights from the researcher’s everyday practice, an adapted model of the Theory of Change based on Weiss (1995) was designed, providing a tool to evaluate the effects of rehabilitation on cultural significance [ERECS]. Using a selection of six recently rehabilitated historic secondary schools in Portugal (liceus), this research investigated architectural decisions and their effects on the cultural values of this building typology for education, focusing on three objectives, corresponding to three stages of interventions: understanding the existing cultural significance, identifying the design strategies applied and assessing the short-term effects of design decisions on the cultural values. Stressing the role of stakeholders in rehabilitation processes, data were collected from the buildings and architectural projects, the decision makers in the conservation process, and the school community. Although confirming that the evaluation of the effects of architectural decisions on cultural values is a complex task, the findings demonstrate that the historic liceus have historical, architectural and sociocultural values, and whilst strategies did not value social values, material cultural values were generally considered and preserved, contributing to the enhancement of intangible values. The implications of this theory-based and evidence-based research highlight the importance of evaluating actual effects for cultural heritage theory, architectural conservation practice and heritage management policy.

Intercultural Management

Globalization has increasingly brought permanent contact with people whose cultural background is different from what many would consider their ‘own’ culture. The area of intercultural management is of critical interest due to the impact of increased European and global migration, which has required health and social care leaders and managers to develop competency to respond to the diversity and changing needs of their workforce and service users. The communities within the European Union are now often characterised by significant diversity whether at cultural, social, or psychological levels. The purpose of this chapter is to enable health and social care practitioners to assume a clinical/ professional leadership role in quality intercultural management in the health and social care sector. This chapter will focus on developing health and social care practitioners’ knowledge and understanding in the area of intercultural management within contemporary health and social care organisations. It will focus on the critical application of knowledge to practice through the provision of underpinning knowledge, understanding and debates surrounding contemporary issues and practices in the areas of intercultural management. Many practitioners accessing this information may already work in the heath/social sector and this critical focus on intercultural and diversity management has the potential to improve the quality in health and social care services through the critical application to practice.

Soil management, seed treatment and soil compaction on the sowing furrows affect grain yields of upland rice genotypes.

The water availability for flood irrigated rice (Oryza sativa L.) is decreasing worldwide. Therefore, developing technologies to allow growing rice in aerobic condition, such as a no-tillage system (NTS) can contribute to produce upland rice grains without yield losses and also in saving more water. The objective of this study was to determine the effect of soil management, seed treatment and compaction on the sowing furrow on grain yield of upland rice genotypes. We made two trials, one in an NTS and another using conventional tillage, CT (one plowing and two diskings). The field experiments were performed in the Central Region of Brazil in Cerrado soils. For each trial, the experimental design was a randomized block design in a factorial scheme, with three replications. The treatments consisted of a combination of 10 genotypes with 2 compaction pressures on the sowing furrow (25 kPa and 126kPa) and 2 types of seed treatment (with and without pesticide). Under CT, the seed treatment did not contribute to increase upland rice grain yields. However, under NTS the grain yield of some genotypes [BRS Esmeralda (from 723 to 1,766 kg ha-1), BRS Pepita (from 930 to 1,874 kg ha-1), AB072044 (from 523 to 1,579 kg ha-1), and AB072085 (from 632 to 1,636 kg ha-1) at 25 kPA soil compaction pressure, and Sertaneja (from 994 to 2,167 kg ha-1), BRS Pepita (from 1,161 to 2,100 kg ha-1), and AB072085 (from 958 to 2,213 kg ha-1), at 126 kPA soil compaction pressure] increased with the use of this practice. At CT the higher soil compaction pressure on the sowing furrow (from 25 kPa to 126 kPa) increased rice grain yield only when it was used seed treatment and the genotypes Serra Dourada (from 1,239 to 2,178 kg ha-1), Sertaneja (from 1,510 to 2,379 kg ha-1), and Cambará (from 1,877 to 2,831 kg ha-1). On the other hand, under NTS, increasing soil compaction pressure on the sowing furrow allowed for an increased rice grain yield of Serra Dourada (from 1,553 to 2,347 kg ha-1), Esmeralda (from 723 to 1,643 kg ha-1), AB072044 (from 523 to 2,040 kg ha-1), and Cambará (from 1,243 to 2,032 kg ha-1) without seed treatment and Sertaneja (from 1,385 to 2,167 kg ha-1) and AB072044 (from 1,579 to 2,356 kg ha-1) with seed treatment. In CT the most productive genotypes were AB062008 (2,714 kg ha-1) and BRSMG Caravera (2,479 kg ha-1), while at NTS were the genotypes: BRSGO Serra Dourada (2,118 kg ha-1), AB072047 (1,888 kg ha-1), AB062008 (1,823 kg ha-1), BRSMG Caravera (1,737 kg ha-1), Cambará (1,716 kg ha-1), AB072044 (1,625 kg ha-1), BRS Esmeralda (1,604 kg ha-1), and BRS Pepita (1,516 kg ha-1).

Comparison of Explicit and Implicit Methods of Cross-Cultural Learning in an International Classroom

The paper addresses a gap in the literature concerning the difference between enhanced and not enhanced cross-cultural learning in an international classroom. The objective of the described research was to clarify if the environment of international classrooms could enhance cross-cultural competences significantly enough or if additional focus on cross-cultural learning as an explicit objective of learning activities would add substantially to the experience. The research question was defined as “how can a specific exercise focused on cross-cultural learning enhance the cross-cultural skills of university students in an international classroom?”. Surveys were conducted among interna- tional students in three leading Central-European Universities in Lithuania, Poland and Hungary to measure the increase of their cross-cultural competences. The Lithuanian and Polish classes were composed of international students and concentrated on International Management/Business topics (explicit method). The Hungarian survey was done in a general business class that just happened to be international in its composition (implicit method). Overall, our findings prove that the implicit method resulted in comparable, somewhat even stronger effectiveness than the explicit method. The study method included the analyses of students’ individual increases in each study dimension and construction of a compound measure to note the overall results. Our findings confirm the power of the international classroom as a stimulating environment for latent cross-cultural learning even without specific exercises focused on cross-cultural learning itself. However, the specific exercise did induce additional learning, especially related to cross-cultural awareness and communication with representatives of other cultures, even though the extent of that learning may be interpreted as underwhelming. The main conclusion from the study is that the diversity of the students engaged in a project provided an environment that supported cross-cultural learning, even without specific culture-focused reflections or exercises.

Circumplex Model to analyze the impact of emotions on decision-making processes in innovation management

Group work allows participants to pool their thoughts and examine difficulties from several angles. In these settings, it is possible to attempt things that an individual could not achieve, combining a variety of abilities and knowledge to tackle more complicated and large-scale challenges. That’s why nowadays collaborative work is becoming more and more widespread to solve complex innovation dilemmas. Since innovation isn’t a tangible thing, most innovation teams used to take decisions based on performance KPIs such as forecasted engagement, projected profitability, investments required, cultural impacts etc. Have you ever wondered the reason why sometimes innovation group processes come out with decisions which are not the optimal meeting point of all the KPIs? Has this decision been influenced by other factors? Some researchers account part of this phenomenon to the emotions in group-based interaction between participants. I will develop a literature review that is split into three parts: first, I will consider some emotions theories from an individual perspective; secondly, a wider view of collective interactions theories will be provided; lastly, I will supply some recent collective interaction empirical studies. After the theoretical and empirical gaps have been tackled, the study will additionally move forward with a methodological point of view, about the Circumplex Model, which is the model I used to evaluate emotions in my research. This model has been applied to SUGAR project, which is the biggest design thinking academy worldwide.

A Decade Of Malaria During Pregnancy In Brazil: What Has Been Done Concerning Prevention And Management.

In Brazil, malaria remains a disease of major epidemiological importance because of the high number of cases in the Amazonian Region. Plasmodium spp infections during pregnancy are a significant public health problem with substantial risks for the pregnant woman, the foetus and the newborn child. In Brazil, the control of malaria during pregnancy is primarily achieved by prompt and effective treatment of the acute episodes. Thus, to assure rapid diagnosis and treatment for pregnant women with malaria, one of the recommended strategy for low transmission areas by World Health Organization and as part of a strategy by the Ministry of Health, the National Malaria Control Program has focused on integrative measures with woman and reproductive health. Here, we discuss the approach for the prevention and management of malaria during pregnancy in Brazil over the last 10 years (2003-2012) using morbidity data from Malaria Health Information System. Improving the efficiency and quality of healthcare and education and the consolidation of prevention programmes will be challenges in the control of malaria during pregnancy in the next decade.

Management Of Severe Thoracic Impalement Trauma Against Two-wheeled Horse Carriage: A Case Report And Literature Review.

Thoracic injuries in general are of great importance due to their high incidence and high mortality. Thoracic impalement injuries are rare but severe due to the combination of cause, effect and result. This study's primary objective is to report the case of a young man who was impaled by a two-wheeled horse carriage shaft while crashing his motorcycle in a rural zone. An EMT-B ferry was called at the crash scene and a conscious patient was found, sustaining a severe impalement injury to the left hemithorax, suspended over the floor by the axial skeleton with the carriage shaft coming across his left chest. As a secondary objective, a literature review of thoracic impalement injuries is performed. Cases of thoracic impalement injury require unique and individualized care based on injury severity and affected organs. Reported protocols for managing impalement injuries are entirely anecdotal, with no uniformity on impaled patient's approach and management. In penetrating trauma, it is essential not to remove the impaled object, so that possible vascular lesions remain buffered by the object, avoiding major bleeding and exsanguination haemorrhage. Severed impaled thoracic patients should be transferred to a specialist centre for trauma care, as these lesions typically require complex multidisciplinary treatment. High-energy thoracic impalement injuries are rare and hold a high mortality rate, due to the complexity of trauma and associated injuries such as thoracic wall and lung lesions. Modern medicine still seems limited in cases of such seriousness, not always with satisfactory results.

Key Issues In Inhibitor Management In Patients With Haemophilia.

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[consensus Of The Brazilian Society Of Rheumatology For The Diagnosis, Management And Treatment Of Lupus Nephritis].

To develop recommendations for the diagnosis, management and treatment of lupus nephritis in Brazil. Extensive literature review with a selection of papers based on the strength of scientific evidence and opinion of the Commission on Systemic Lupus Erythematosus members, Brazilian Society of Rheumatology. 1) Renal biopsy should be performed whenever possible and if this procedure is indicated; and, when the procedure is not possible, the treatment should be guided with the inference of histologic class. 2) Ideally, measures and precautions should be implemented before starting treatment, with emphasis on attention to the risk of infection. 3) Risks and benefits of treatment should be shared with the patient and his/her family. 4) The use of hydroxychloroquine (preferably) or chloroquine diphosphate is recommended for all patients (unless contraindicated) during induction and maintenance phases. 5) The evaluation of the effectiveness of treatment should be made with objective criteria of response (complete remission/partial remission/refractoriness). 6) ACE inhibitors and/or ARBs are recommended as antiproteinuric agents for all patients (unless contraindicated). 7) The identification of clinical and/or laboratory signs suggestive of proliferative or membranous glomerulonephritis should indicate an immediate implementation of specific therapy, including steroids and an immunosuppressive agent, even though histological confirmation is not possible. 8) Immunosuppressives must be used during at least 36 months, but these medications can be kept for longer periods. Its discontinuation should only be done when the patient achieve and maintain a sustained and complete remission. 9) Lupus nephritis should be considered as refractory when a full or partial remission is not achieved after 12 months of an appropriate treatment, when a new renal biopsy should be considered to assist in identifying the cause of refractoriness and in the therapeutic decision.

Conservative Management For Lingual Thyroid Ectopic.

Lingual thyroid gland is a rare clinical entity. The presence of an ectopic thyroid gland located at the base of the tongue may be presented with symptoms like dysphagia, dysphonia, and upper airway obstruction. We are introducing a case of an 8-year-old girl who had lingual thyroid that presented dysphagia and foreign body sensation in the throat. The diagnostic was reached with clinical examination, thyroid scintigraphy with Tc(99m) and ultrasound. A laryngoscopy was performed which confirmed a spherical mass at base of tongue. Investigation should include thyroid function tests. In this case we observed subclinical hypothyroidism. There are different types of surgical approaches for the treatment of this condition; however, the treatment with Levothyroxine Sodium allowed the stabilization of TSH levels and clinical improvement of symptoms in a follow-up of 2 years.

Dysphagia Progression And Swallowing Management In Parkinson's Disease: An Observational Study.

Dysphagia is relatively common in individuals with neurological disorders. To describe the swallowing management and investigate associated factors with swallowing in a case series of patients with Parkinson's disease. It is a long-term study with 24 patients. The patients were observed in a five-year period (2006-2011). They underwent Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale and therapeutic intervention every three months. In the therapeutic intervention they received orientation about exercises to improve swallowing. The Chi-square, Kruskal-Wallis and Fisher's tests were used. The period of time for improvement or worsening of swallowing was described by Kaplan-Meier analysis. During the follow-up, ten patients improved, five stayed the same and nine worsened their swallowing functionality. The median time for improvement was ten months. Prior to the worsening there was a median time of 33 months of follow-up. There was no associated factor with improvement or worsening of swallowing. The maneuvers frequently indicated in therapeutic intervention were: chin-tuck, bolus consistency, bolus effect, strengthening-tongue, multiple swallows and vocal exercises. The swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series.

Homogeneidade e heterogeneidade nos sistemas educacionais: Argentina, Brasil, Chile e México

This study focus on the reconfiguration of educational management in Argentina, Brazil, Chile and Mexico, which was promoted by the new logic of social regulation and the new role attributed to the State, considering each country's own historicity. So, the cultural factors that interfere on the dynamics of the 90' school reform are analyzed. Aspects that show the homogeneity or heterogeneity of these reforms in the region, as well as local specificities that block out the concretization of the reform are underlined. It is shown that the historicity that characterizes the educational reform has taken, in each country, a form that can be called, in Mexico, conservative rupture; in Chile, conservative continuity; in Brazil, conservative renovation; and, in Argentina, interrupted rupture. Some conclusions about the impact of educational reform in the selected countries are recuperated through the analysis of 186 academic texts on the subject.

Tradução para a língua portuguesa e adaptação cultural do questionário Rowe modificado para atletas arremessadores

OBJECTIVE: Study was to translate and culturally adapt the modified Rowe score for overhead athletes. METHODS: The translation and cultural adaptation process initially involved the stages of transla tion, synthesis, back-translation, and revision by the Translation Group. It was than created the pre-final version of the question naire, being the areas function and pain applied to 20 athletes that perform overhead movements and that suffered SLAP lesions in the dominant shoulder and the areas active compression test and anterior apprehension test and motion were applied to 15 health professionals. RESULTS: During the translation process there were made little modifications in the questionnaire in order to adapt it to Brazilian culture, without changing the semantics and the idiomatic concept originally described. CONCLUSIONS: The questionnaire was easily understood by the subjects of the study, being possible to obtain the Brazilian version of the modified Rowe score for over head athletes that underwent surgical treatment of the SLAP lesion.

Pesquisa qualitativa em Educação Física: possibilidades de construção de conhecimento a partir do referencial cultural

This work indicates presuppositions for the qualitative research in Physical Education, starting with a literature review based on the cultural frame of reference. Firstly, we introduce the debate concerning the natural and the human sciences and implications for the Physical Education; we then use a cultural axis as a ground basis for the research in the area, proposing the 'dense description' as a possibility for knowledge building; finally, we bring up examples of studies conducted with such an approach. This theoretical methodological approach allows the study of the human being as a cultural being, thus opposed to the naturalised view of a human - predominant in Physical Education.