A METHODOLOGY TO EVALUATE OBSOLETE INVENTORY IN HEALTH CARE

Many organizations are currently facing inventory management problems such as distributing inventory on-time and maintain the correct inventory levels to satisfy the customer or end users. Organizations understand the need for maintaining the accurate inventory levels but sometimes fall short leading a wide performance gap in maintaining inventory accurately. The inventory inaccuracy can consume much of the investment on purchasing inventory and many times leads to excessive inventory. The research objective of thesis is to provide a decision making criteria to the management for closing or maintaining the warehouse based on basic purchasing and holding cost information. The specific objectives provide information regarding the impact of inventory carrying cost, obsolete inventory, inventory turns. The methodology section explains about the carrying cost ratio that would help inventory managers to adopt best practices to avoid obsolete inventory and also reduce excessive inventory levels. The research model was helpful in providing a decision making criteria based on the performance metric developed. This research model and performance metric had been validated by analysis of warehouse data and results indicated a shift from two-echelon inventory supply chain to a one-echelon or Just In Time (JIT) based inventory supply chain. The recommendations from the case study were used by a health care organization to reorganize the supply chain resulting in the reduction of excessive inventory.

Clinical trial design in non-invasive brain stimulation psychiatric research

Major depressive disorder (MDD) trials - investigating either non-pharmacological or pharmacological interventions - have shown mixed results. Many reasons explain this heterogeneity, but one that stands out is the trial design due to specific challenges in the field. We aimed therefore to review the methodology of non-invasive brain stimulation (NIBS) trials and provide a framework to improve clinical trial design. We performed a systematic review for randomized, controlled MDD trials whose intervention was transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) in MEDLINE and other databases from April 2002 to April 2008. We created an unstructured checklist based on CONSORT guidelines to extract items such as power analysis, sham method, blinding assessment, allocation concealment, operational criteria used for MDD, definition of refractory depression and primary study hypotheses. Thirty-one studies were included. We found that the main methodological issues can be divided in to three groups: (1) issues related to phase II/small trials, (2) issues related to MDD trials and, (3) specific issues of NIBS studies. Taken together, they can threaten study validity and lead to inconclusive results. Feasible solutions include: estimating the sample size a priori; measuring the degree of refractoriness of the subjects; specifying the primary hypothesis and statistical tests; controlling predictor variables through stratification randomization methods or using strict eligibility criteria; adjusting the study design to the target population; using adaptive designs and exploring NIBS efficacy employing biological markers. In conclusion, our study summarizes the main methodological issues of NIBS trials and proposes a number of alternatives to manage them. Copyright (C) 2011 John Wiley & Sons, Ltd.

THE INTERNATIONAL CLASSIFICATION OF PUBLIC HEALTH NURSING PRACTICES - CIPESC (R): A PEDAGOGICAL TOOL FOR EPIDEMIOLOGICAL STUDIES

The CIPESC (R) is a tool that informs the work of nurses in Public Health and assists in prioritizing their care in practice, management and research. It is also a powerful pedagogical instrument for the qualification of nurses within the Brazilian healthcare system. In the teaching of infectious diseases, using the CIPESC (R) assists in analyzing the interventions by encouraging clinical and epidemiological thinking regarding the health-illness process. With the purpose in mind of developing resources for teaching undergraduate nursing students and encouraging reflection regarding the process of nursing work, this article presents an experimental application of CIPESC (R), using meningococcal meningitis as an example.

Research Blogging: Indexing and Registering the Change in Science 2.0

Increasing public interest in science information in a digital and 2.0 science era promotes a dramatically, rapid and deep change in science itself. The emergence and expansion of new technologies and internet-based tools is leading to new means to improve scientific methodology and communication, assessment, promotion and certification. It allows methods of acquisition, manipulation and storage, generating vast quantities of data that can further facilitate the research process. It also improves access to scientific results through information sharing and discussion. Content previously restricted only to specialists is now available to a wider audience. This context requires new management systems to make scientific knowledge more accessible and useable, including new measures to evaluate the reach of scientific information. The new science and research quality measures are strongly related to the new online technologies and services based in social media. Tools such as blogs, social bookmarks and online reference managers, Twitter and others offer alternative, transparent and more comprehensive information about the active interest, usage and reach of scientific publications. Another of these new filters is the Research Blogging platform, which was created in 2007 and now has over 1,230 active blogs, with over 26,960 entries posted about peer-reviewed research on subjects ranging from Anthropology to Zoology. This study takes a closer look at RB, in order to get insights into its contribution to the rapidly changing landscape of scientific communication.

Imaginative construction of care: the nursing professional experience in a remote care service

The direction of care delivery goes from the action to the being; a process built from professional experience, which gains special characteristics when the service is delivered by telephone. The goal of this research was to understand the interaction between professionals and users in a remote care service; to do so, a research is presented, using Grounded Theory and Symbolic Interactionism as theoretical references. Data were collected through eight interviews with professionals who deliver care by telephone. The theoretical understanding permitted the creation of the theoretical model of the Imaginative Construction of Care, which shows the interaction processes the professional experiences when delivering care by telephone. In this model, individual and social facts are added, showing the link between the concepts, with special emphasis on uncertainty, sensitivity and professional responsibility, as essential components of this experience.

Development of methodology for determination of pesticides residue in water by SPE/HPLC/DAD

To boost crop yield, sugarcane growers are using increasing amounts of pesticides to combat insects and weeds. But residues of these compounds can pollute water resources, such as lakes, rivers and aquifers. The present paper reports the results of a study of water samples from the Feijao River, which is the source of drinking water for the city of Sao Carlos, Sao Paulo, Brazil. The samples were evaluated for the presence of four leading pesticides - ametryn, atrazine, diuron and fipronil - used on sugarcane, the dominant culture in the region. The samples were obtained from three points along the river: the headwaters, along the middle course of the river and just before the municipal water intake station. The pesticides were extracted from the water samples by solid-phase extraction (SPE) and then analyzed by liquid chromatography with diode array detection (LC-DAD). The analytical method was validated by traditional methods, obtaining recovery values between 90 and 95%, with precision deviations inferior to 2.56%, correlation coefficients above 0.99 and detection and quantification limits varying from 0.02 to 0.05 mg L-1 and 0.07 to 0.17 mg L-1, respectively. No presence of residues of the pesticides was detected in the samples, considering the detection limits of the method employed.

THE VIRTUAL ENVIRONMENT OF A RESEARCH GROUP: THE TUTORS' PERSPECTIVE

The Grupo de Estudos e Pesquisas de Tecnologia da Informacao nos Processos de Trabalho em Enfermagem (Study and Research Group for Information Technology in the Nursing Working Processes, GEPETE) has the purpose of producing and socializing knowledge in information technology and health and nursing communication, making associations with research groups in this field and promoting student participation. This study was performed by the group tutors with the objective to report on the development of the virtual learning environment (VLE) and the tutors' experience as mediators of a research group using the Moodle platform. To do this, a VLE was developed and pedagogical mediation was performed following the theme of mentoring. An initial diagnosis was made of the difficulties in using this technology in interaction and communication, which permitted the proposal of continuing to use the platform as a resource to support research activities, offer lead researchers the mechanisms to socialize projects and offer the possibility of giving advice at a distance.

Research Training Program: Duke University and Brazilian Society of Cardiology

Background: Research coaching program focuses on the development of abilities and scientific reasoning. For health professionals, it may be useful to increase both the number and quality of projects and manuscripts. Objective: To evaluate the initial results and implementation methodology of the Research and Innovation Coaching Program of the Research on Research group of Duke University in the Brazilian Society of Cardiology. Methods: The program works on two bases: training and coaching. Training is done online and addresses contents on research ideas, literature search, scientific writing and statistics. After training, coaching favors the establishment of a collaboration between researchers and centers by means of a network of contacts. The present study describes the implementation and initial results in reference to the years 2011-2012. Results: In 2011, 24 centers received training, which consisted of online meetings, study and practice of the contents addressed. In January 2012, a new format was implemented with the objective of reaching more researchers. In six months, 52 researchers were allocated. In all, 20 manuscripts were published and 49 more were written and await submission and/or publication. Additionally, five research funding proposals have been elaborated. Conclusion: The number of manuscripts and funding proposals achieved the objectives initially proposed. However, the main results of this type of initiative should be measured in the long term, because the consolidation of the national production of high-quality research is a virtuous cycle that feeds itself back and expands over time. (Arq Bras Cardiol 2012;99(6):1075-1081)

WATER HOMEOSTASIS, FRAILTY AND COGNITIVE FUNCTION IN THE NURSING HOME

Objective: - To develop and test a practical clinical method to assess frailty in nursing homes; - To investigate the relationship between cognitive status of the elderly and the balance between water compartments of their body composition. Design and subjects: Cross-sectional study, conducted at two nursing homes in Boston-MA. Methods: Body mass and height (Ht) were evaluated to calculate BMI (body mass index, in Kg/m(2)). The cognitive decline was evaluated based on the scores obtained from the Mini-Mental State Examination (MMSE); The extracellular to total body water ratio (ECW/TBW) was calculated after the analysis of TBW from deuterium and tritium dilution and ECW from bromide dilution. Single-frequency BIA analysis data were investigated for resistance (R) and reactance (Xc), plotted in an R/Ht Xc/Ht graph (vectorial analysis-BIVA). The BIVA results of nursing home residents were compared against the data obtained from the NHANES Ill study. TBW and ECW values were compared with a group of free-living elderly volunteers. Results: The ECW/TBW was significantly higher in nursing home residents than in the free-living individuals. BIVA analysis showed significantly higher Xc/Ht values in the reference subjects. The MMSE did not present a significant correlation with ECW/TBW for either gender. Conclusion: We proposed the ECW/TBW ratio and BIVA as surrogate methods for the clinical assessment of frailty. We tested successfully both approaches with nursing home patients and free-living volunteers and compared them to a national data base. The advent of new, portable instruments will enable field tests to further validate our proposed "Frailty Factor" in future studies. We found no correlation between frailty and cognitive decline in the nursing home.

The Everyday Life in Public Health Research: a theoretical and methodological framework

The aim of this paper is to present some reflections on possibilities to investigate everyday life by examining ways of life, so as to broaden perspectives to the field of research in public health, in light of the fact that the study of daily ways of life involves the analysis of trajectories that contextualize routines, interactions and meanings of life. This allows the social researcher in the health field to have, based on a theoretical framework, a flexible methodology that offers mobility in the choice of the technique that best favors the understanding of the issue to be investigated. We have here, as a conceptual reference, the idea of everyday life investigated from interactive processes and contexts, as opposed to a categorial objectification between subject and object. In this context, from the theoretical reflection, we take, as the research's empirical reference, the waiting room of the outpatient clinic of the Osteoarticular Metabolism Department of a Health Care Unit in the city of Fortaleza/, Northeastern Brazil, in order to foster an interpretive understanding of the daily routine that involves the life and health situations of women with osteoporosis.

RAND-like Appropriateness Methodology Consensus for Primary Open-Angle Glaucoma in Latin America

PURPOSE: To report the results of a Latin American consensus panel regarding the diagnosis and management of primary open-angle glaucoma and to compare these results with those from a similar panel in the United States. DESIGN: A RAND-like (Research and Development) appropriateness methodology was used to assess glaucoma practice in Latin America. METHODS: The 148 polling statements created for the RAND-like analysis in the United States and 10 additional statements specific to glaucoma care in Latin America were presented to a panel of Latin American glaucoma experts. Panelists were polled in private using the RAND-like methodology before and after the panel meeting. RESULTS: Consensus agreement or disagreement among Latin American experts was reached for 51.3% of statements before the meeting and increased to 66.5% in the private, anonymous meeting after polling (79.0% agreement, 21.0% disagreement). Although there was a high degree of concordance (111 of 148 statements; 75%) between the results of this Latin American panel and the United States panel, there were some notable exceptions relating to diagnostic and therapeutic decision making. CONCLUSIONS: This RAND-like consensus methodology provides a perspective of how Latin American glaucoma practitioners view many aspects of glaucoma and compares these results with those obtained using a similar methodology from practitioners in the United States. These findings may be helpful to ophthalmologists providing glaucoma care in Latin America and in other regions of the world. (Am J Ophthalmol 2012;154: 460-465. (C) 2012 by Elsevier Inc. All rights reserved.)

Nursing care time in the Intensive Care Unit: evaluation of the parameters proposed in COFEN Resolution N degrees 293/04

This study aimed to evaluate the parameters established in COFEN Resolution 293/04 concerning nursing staff dimensioning in adult intensive care units (AICU). The research was conducted in six hospitals in Sao Paulo City. The daily quantitative average of professionals needed for patient care was calculated according to the parameters established by COFEN. The obtained results were compared with the existing number of daily staff members in these units. It was observed that the proportions recommended by COFEN for the nurse category are superior to those used in the hospitals studied, which represents a challenge for Brazilian nursing. Mean care time values were found appropriate and represent important standards for dimensioning the minimum number of professionals in AICU. This study contributed to the validation of the parameters indicated in Resolution 293/04 for nursing staff dimensioning in the AICU.

Nursing Workload as a Risk Factor for Healthcare Associated Infections in ICU: A Prospective Study

Introduction: Nurse understaffing is frequently hypothesized as a potential risk factor for healthcare-associated infections (HAI). This study aimed to evaluate the role of nursing workload in the occurrence of HAI, using Nursing Activities Score (NAS). Methods: This prospective cohort study enrolled all patients admitted to 3 Medical ICUs and one step-down unit during 3 months (2009). Patients were followed-up until HAI, discharge or death. Information was obtained from direct daily observation of medical and nursing rounds, chart review and monitoring of laboratory system. Nursing workload was determined using NAS. Non-compliance to the nurses' patient care plans (NPC) was identified. Demographic data, clinical severity, invasive procedures, hospital interventions, and the occurrence of other adverse events were also recorded. Patients who developed HAI were compared with those who did not. Results: 195 patients were included and 43 (22%) developed HAI: 16 pneumonia, 12 urinary-tract, 8 bloodstream, 2 surgical site, 2 other respiratory infections and 3 other. Average NAS and average proportion of non compliance with NPC were significantly higher in HAI patients. They were also more likely to suffer other adverse events. Only excessive nursing workload (OR: 11.41; p: 0.019) and severity of patient's clinical condition (OR: 1.13; p: 0.015) remained as risk factors to HAI. Conclusions: Excessive nursing workload was the main risk factor for HAI, when evaluated together with other invasive devices except mechanical ventilation. To our knowledge, this study is the first to evaluate prospectively the nursing workload as a potential risk factor for HAI, using NAS.

Intelligence systems methodology: a systemic approach to the organizational intelligence function

Organizational intelligence can be seen as a function of the viable structure of an organization. With the integration of the Viable System Model and Soft Systems Methodology (systemic approaches of organizational management) focused on the role of the intelligence function, it is possible to elaborate a model of action with a structured methodology to prospect, select, treat and distribute information to the entire organization that improves the efficacy and efficiency of all processes. This combination of methodologies is called Intelligence Systems Methodology (ISM) whose assumptions and dynamics are delimited in this paper. The ISM is composed of two simultaneous activities: the Active Environmental Mapping and the Stimulated Action Cycle. The elaboration of the formal ISM description opens opportunities for applications of the methodology on real situations, offering a new path for this specific issue of systems thinking: the intelligence systems. Knowledge Management Research & Practice (2012) 10, 141-152. doi:10.1057/kmrp.2011.44

Software Application That Evaluates the Diagnostic Accuracy of Nursing Students

PURPOSE: Apply the educational software Fuzzy Kitten with undergraduate Brazilian nursing students. METHODS: This software, based on fuzzy logic, generates performance scores that evaluate the ability to identify defining characteristics/risk factors present in clinical cases, relate them with nursing diagnoses, and determine the diagnoses freely or using a decision support model. FINDINGS: There were differences in student performance compared to the year of the course. The time to perform the activity did not present a significant relation to the performance. The students' scores in the diagnoses indicated by the model was superior (p = .01). CONCLUSIONS: The software was able to evaluate the diagnostic accuracy of students. IMPLICATIONS: The software enables an objective evaluation of diagnostic accuracy.