Intervenções de enfermagem à pessoa com Diabetes Mellitus tipo 2 em cuidados de saúde primários: elaboração de uma norma de orientação clínica

Enquadramento: Vários estudos apontam que em contexto de Cuidados de Saúde Primários (CSP), programas organizados de cuidados de enfermagem podem promover significativamente melhores resultados de saúde em pessoas com diabetes. O Programa Nacional de Prevenção e Controlo da Diabetes estabelece, como objetivo, uniformizar as práticas profissionais em prol de uma efetiva qualidade clínica, organizacional e satisfação das pessoas com diabetes. A Federação Internacional de Diabetes e a OMS enfatizam a necessidade de os programas nacionais de saúde implementarem guias de boas práticas baseadas em evidência para a prevenção e controlo da DM. Tendo como principal problema a inexistência de uma orientação específica que norteie as intervenções a prestar na consulta de enfermagem à pessoa com Diabetes Mellitus tipo 2 (DM2) em CSP o presente trabalho teve por objetivos: (I) Consensualizar intervenções que devem ser realizadas pelos enfermeiros na consulta à pessoa com DM2 em CSP, (II) Elaborar uma Norma de Orientação Clinica (NOC) baseada em evidência científica para orientação da consulta de enfermagem à pessoa com DM2 em CSP. Metodologia: Foi realizado um Painel de Delphi, para a obtenção de consenso, acerca das intervenções a serem realizadas na consulta de enfermagem à pessoa com DM2 em CSP. Para suportar em evidência científica as intervenções obtidas por consenso e, consequentemente, elaborar a NOC utilizámos o Processo ADAPTE, que permite a adaptação de Normas já existentes através de uma abordagem sistemática para a aprovação e/ou modificação destas1. Resultados: Elaboração de uma NOC adaptada baseada em evidência científica, para suporte à consulta de enfermagem à pessoa com DM2 em CSP.

Caracterização das práticas seguras de medicação nos hospitais portugueses: contributo para o desenvolvimento de um instrumento

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

Greece painted by John Fulleylove, R.I.,

Each plate is accompanied by guard sheet with descriptive letterpress.

Le culte d'Apollon Pythien à Athènes,

Mode of access: Internet.

Aufsätze über Goethe,

A collection of articles published in various magazines from 1874 to 1885, edited with "Vorwort" and notes by Erich Schmidt.

L'administration financière du sanctuaire pythique au IVe siècle avant J.-C.,

Series title also on cover.

Le temple d'Athéna Pronaia ...

Extraite de la Revue de l'art ancien et moderne, no. 19.

Measurement of community beliefs about colorectal cancer

Few educational campaigns have focused on bowel cancer, though studies have indicated that members of the community need and want current information about relevant issues. In order to facilitate research in this area, reliable and valid measures of community attitudes are needed. Content validity of a survey instrument was obtained through use of a Delphi process with Directors of Education from the Australia Cancer Council and focus group discussions with informed members of the public. The subsequent survey of community perceptions about colorectal cancer included a broad range of content areas related to the risk of bowel cancer, preventing and coping with bowel cancer and beliefs about susceptibility and severity. The construct validity of these content areas was investigated by use of a factor analysis and confirmation of an association with related predictor variables. Two measures related to personal influence and anticipated coping responses showed favourable psychometric properties, including moderate to high levels of internal consistency and test-retest reliability. A test of the concurrent validity of these measures requires further development of instruments related to colorectal cancer or adaptation of measures from other areas of health research. (C) 2000 Elsevier Science Ltd. All rights reserved.

Establishing a zone where technology innovation is supported

Learning technologies are now a ubiquitous force in the higher education sector however we continue to pursue more inventive ways to use them for teaching and learning. Many teaching academics that seek to be innovative do not have access to a supportive technology innovation zone. The aim of this study was to investigate the articulated staff development needs of academics involved in a faculty based technology innovation project and create the conditions that would cultivate innovation. The study sought to find out how academics perceived they might best be assisted through their technology innovation process so that participants’ needs were incorporated into planning. A questionnaire was used to elicit background information about the academics’ experience, skills and self diagnosed skill deficits in this context. Participants were also requested to provide information about how they thought they would best acquire the skills given their time and other resource constraints. A modified Delphi Technique was utilised to achieve some consensus on what academics required to support technology innovation. Complemented by an enabling and empowering team based approach, the academics were provided with an innovation zone to achieve significant goals for the project.

Comparison of ASAS improvement criteria for ankylosing spondylitis with clinically relevant improvement according to an expert panel

Objective: To investigate whether the recently developed (statistically derived) "ASsessment in Ankylosing Spondylitis Working Group" improvement criteria (ASAS-IC) for ankylosing spondylitis (AS) reflect clinically relevant improvement according to the opinion of an expert panel. Methods: The ASAS-IC consist of four domains: physical function, spinal pain, patient global assessment, and inflammation. Scores on these four domains of 55 patients with AS, who had participated in a non-steroidal anti-inflammatory drug efficacy trial, were presented to an international expert panel (consisting of patients with AS and members of the ASAS Working Group) in a three round Delphi exercise. The number of (non-) responders according to the ASAS-IC was compared with the final-consensus of the experts. The most important domains in the opinion of the experts were identified, and also selected with discriminant analysis. A number of provisional criteria sets that best represented the consensus of the experts were defined. Using other datasets, these clinically derived criteria sets as well as the statistically derived ASAS-IC were then tested for discriminative properties and for agreement with the end of trial efficacy by patient and doctor. Results: Forty experts completed the three Delphi rounds. The experts considered twice as many patients to be responders than the ASAS-IC (42 v 21). Overall agreement between experts and ASAS-IC was 62%. Spinal pain was considered the most important domain by most experts and was also selected as such by discriminant analysis. Provisional criteria sets with an agreement of greater than or equal to 80% compared with the consensus of the experts showed high placebo response rates (27-42%), in contrast with the ASAS-IC with a predefined placebo response rate of 25%. All criteria sets and the ASAS-IC discriminated well between active and placebo treatment (chi(2) = 36-45; p < 0.001). Compared with the end of trial efficacy assessment, the provisional criteria sets showed an agreement of 71-82%, sensitivity of 67-83%, and specificity of 81-88%. The ASAS-IC showed an agreement of 70%, sensitivity of 62%, and specificity of 89%. Conclusion: The ASAS-IC are strict in defining response, are highly specific, and consequently show lower sensitivity than the clinically derived criteria sets. However, those patients who are considered as responders by applying the ASAS-IC are acknowledged as such by the expert panel as well as by. patients' and doctors' judgments, and are therefore likely to be true responders.

A COMUNICAÇÃO ORGANIZACIONAL INTERNA E O AMBIENTE VIRTUAL: NOVAS TENDÊNCIAS

Esta tese trata do impacto nas Comunicações Internas das Organizações em relação à virtualidade e teve como objetivo descrever e analisar as mudanças ocorridas na comunicação interna das organizações privadas com o advento das tecnologias. Para atingir nosso objetivo fizemos uso da pesquisa bibliográfica, partindo do exame das teorias comunicacionais disponíveis e dos recursos técnicos inerentes à comunicação e às tecnologias da informação aplicadas à organização. Estabelecemos a convergência em relação às tendências e efeitos que poderão ser observados, por meio de um diálogo com especialistas da área Comunicacional através de um estudo qualitativo, onde fizemos uso da metodologia do Painel Delphi com o intuito de descrevermos e analisarmos as mudanças ocorridas nos meios, analisarmos seus impactos e traçarmos um cenário futuro em relação à utilização das tecnologias da informação e comunicação no ambiente organizacional interno. Os resultados de nossa pesquisa demonstraram que a comunicação interna organizacional deverá ser intensamente mediada por computador, mas não se limitará a ele, justamente pela realidade e condição cultural de cada organização, um mix comunicacional (com veículos tradicionais e virtuais) deverá ser a condição mais lógica para uma comunicação eficiente, uma vez que abrange todo o tipo de público e formato de mensagens.(AU)

A COMUNICAÇÃO ORGANIZACIONAL INTERNA E O AMBIENTE VIRTUAL: NOVAS TENDÊNCIAS

Esta tese trata do impacto nas Comunicações Internas das Organizações em relação à virtualidade e teve como objetivo descrever e analisar as mudanças ocorridas na comunicação interna das organizações privadas com o advento das tecnologias. Para atingir nosso objetivo fizemos uso da pesquisa bibliográfica, partindo do exame das teorias comunicacionais disponíveis e dos recursos técnicos inerentes à comunicação e às tecnologias da informação aplicadas à organização. Estabelecemos a convergência em relação às tendências e efeitos que poderão ser observados, por meio de um diálogo com especialistas da área Comunicacional através de um estudo qualitativo, onde fizemos uso da metodologia do Painel Delphi com o intuito de descrevermos e analisarmos as mudanças ocorridas nos meios, analisarmos seus impactos e traçarmos um cenário futuro em relação à utilização das tecnologias da informação e comunicação no ambiente organizacional interno. Os resultados de nossa pesquisa demonstraram que a comunicação interna organizacional deverá ser intensamente mediada por computador, mas não se limitará a ele, justamente pela realidade e condição cultural de cada organização, um mix comunicacional (com veículos tradicionais e virtuais) deverá ser a condição mais lógica para uma comunicação eficiente, uma vez que abrange todo o tipo de público e formato de mensagens.

Introduction: improving manufacturing performance through technology diffusion, implementation and management

The role of technology management in achieving improved manufacturing performance has been receiving increased attention as enterprises are becoming more exposed to competition from around the world. In the modern market for manufactured goods the demand is now for more product variety, better quality, shorter delivery and greater flexibility, while the financial and environmental cost of resources has become an urgent concern to manufacturing managers. This issue of the International Journal of Technology Management addresses the question of how the diffusion, implementation and management of technology can improve the performance of manufacturing industries. The authors come from a large number of different countries and their contributions cover a wide range of topics within this general theme. Some papers are conceptual, others report on research carried out in a range of different industries including steel production, iron founding, electronics, robotics, machinery, precision engineering, metal working and motor manufacture. In some cases they describe situations in specific countries. Several are based on presentations made at the UK Operations Management Association's Sixth International Conference held at Aston University at which the conference theme was 'Achieving Competitive Edge: Getting Ahead Through Technology and People'. The first two papers deal with questions of advanced manufacturing technology implementation and management. Firstly Beatty describes a three year longitudinal field study carried out in ten Canadian manufacturing companies using CADICAM and CIM systems. Her findings relate to speed of implementation, choice of system type, the role of individuals in implementation, organization and job design. This is followed by a paper by Bessant in which he argues that a more a strategic approach should be taken towards the management of technology in the 1990s and beyond. Also considered in this paper are the capabilities necessary in order to deploy advanced manufacturing technology as a strategic resource and the way such capabilities might be developed within the firm. These two papers, which deal largely with the implementation of hardware, are supplemented by Samson and Sohal's contribution in which they argue that a much wider perspective should be adopted based on a new approach to manufacturing strategy formulation. Technology transfer is the topic of the following two papers. Pohlen again takes the case of advanced manufacturing technology and reports on his research which considers the factors contributing to successful realisation of AMT transfer. The paper by Lee then provides a more detailed account of technology transfer in the foundry industry. Using a case study based on a firm which has implemented a number of transferred innovations a model is illustrated in which the 'performance gap' can be identified and closed. The diffusion of technology is addressed in the next two papers. In the first of these, by Lowe and Sim, the managerial technologies of 'Just in Time' and 'Manufacturing Resource Planning' (or MRP 11) are examined. A study is described from which a number of factors are found to influence the adoption process including, rate of diffusion and size. Dahlin then considers the case of a specific item of hardware technology, the industrial robot. Her paper reviews the history of robot diffusion since the early 1960s and then tries to predict how the industry will develop in the future. The following two papers deal with the future of manufacturing in a more general sense. The future implementation of advanced manufacturing technology is the subject explored by de Haan and Peters who describe the results of their Dutch Delphi forecasting study conducted among a panel of experts including scientists, consultants, users and suppliers of AMT. Busby and Fan then consider a type of organisational model, 'the extended manufacturing enterprise', which would represent a distinct alternative pure market-led and command structures by exploiting the shared knowledge of suppliers and customers. The three country-based papers consider some strategic issues relating manufacturing technology. In a paper based on investigations conducted in China He, Liff and Steward report their findings from strategy analyses carried out in the steel and watch industries with a view to assessing technology needs and organizational change requirements. This is followed by Tang and Nam's paper which examines the case of machinery industry in Korea and its emerging importance as a key sector in the Korean economy. In his paper which focuses on Venezuela, Ernst then considers the particular problem of how this country can address the problem of falling oil revenues. He sees manufacturing as being an important contributor to Venezuela's future economy and proposes a means whereby government and private enterprise can co-operate in development of the manufacturing sector. The last six papers all deal with specific topics relating to the management manufacturing. Firstly Youssef looks at the question of manufacturing flexibility, introducing and testing a conceptual model that relates computer based technologies flexibility. Dangerfield's paper which follows is based on research conducted in the steel industry. He considers the question of scale and proposes a modelling approach determining the plant configuration necessary to meet market demand. Engstrom presents the results of a detailed investigation into the need for reorganising material flow where group assembly of products has been adopted. Sherwood, Guerrier and Dale then report the findings of a study into the effectiveness of Quality Circle implementation. Stillwagon and Burns, consider how manufacturing competitiveness can be improved individual firms by describing how the application of 'human performance engineering' can be used to motivate individual performance as well as to integrate organizational goals. Finally Sohal, Lewis and Samson describe, using a case study example, how just-in-time control can be applied within the context of computer numerically controlled flexible machining lines. The papers in this issue of the International Journal of Technology Management cover a wide range of topics relating to the general question of improving manufacturing performance through the dissemination, implementation and management of technology. Although they differ markedly in content and approach, they have the collective aim addressing the concepts, principles and practices which provide a better understanding the technology of manufacturing and assist in achieving and maintaining a competitive edge.

Identifying criteria for the assessment of pharmacy students' communication skills with patients

Objectives To identify criteria by which patients can assess the communication skills of pharmacy students. Method Potential assessment criteria were generated from 2 main sources: a literature review and a focus group discussion. A modified two-round Delphi survey was subsequently conducted with 35 professionals who were actively involved in teaching and assessing communication skills of pharmacy students to determine the importance and reliability of each criterion. Results Consensus ratings identified 7 criteria that were important measures of pharmacy students' communication skills and could be reliably assessed by patients. Conclusions A modified two-round Delphi consultation survey successfully identified criteria that can be used by patients to assess the communication skills of pharmacy undergraduates. Future work will examine the feasibility of using patients as assessors of communication skills of pharmacy students, preregistration pharmacists, and qualified pharmacists.

Analysis of organisational climate to improve the adequacy of primary health care in the State of Kuwait

This study covers two areas of contribution to the knowledge, firstly it tried to investigate rigourously the relationships of a number of factors believed that they may affect the climate perception, classified into three types to arrive to prove a hypothesis of the important role that qualification and personal factors play in shaping the climate perception, this is in contrast with situational factors. Secondly, the study tries to recluster the items of a wide-range applied scale for the measurement of climate named HAY in order to overcome the cross-cultural differences between the Kuwaiti and the American society, and to achieve a modified dimensions of climate for a civil service organisation in Kuwait. Furthermore, the study attempts to carry out a diagnostic test for the climate of the Ministry of Public Health in Kuwait, aiming to diagnose the perceived characteristics of the MoPH organisation, and suggests a number of areas to be given attention if an improvement is to be introduced. The study used extensively the statistical and the computer facilities to make the analysis more representing the field data, on the other hand this study is characterised by the very highly responsive rate of the main survey which would affect the findings reliability. Three main field studies are included, the first one was to conduct the main questionnaire where the second was to measure the "should be" climate by the experts of MoPH using the DELPHI technique, and the third was to conduct an extensive meeting with the very top management team in MoPH. Results of the first stage were subject to CLUSTER analysis for the reconstruction of the HAY tool, whereas comparative analysis was carried on between the results of the second and third stages on one side, the first from the other.