Cost accountancy and cost control in hospitals

It is a fact that there now exists a sound framework of accounting theory to ascertain the working results and the investment status of hospitals. Yet, there is no system of accounting in practice to conduct its activities with utmost efficiency. No attempts have hitherto been made for the continuous improvement in the servics rendered by hospitals. Personal investments in hospitals have made the interaction of business to some extent.Planning, decision making and control assume increasing importance as hospitals grow in size and complexity. Moreover, wise and effective utilisation of resources should be ensured. The importance of cost cannot be overlooked in this context. Cost is the most effective factor in the determination of the prices of hospital services rendered. The important managerial functions have to rely heavily on accurate and timely cost information. More people can be provided with services if no services cost more than what is a must to provide the necessary level of care. The price paid for high cost technology for a few is no technology at all for the many. Hence no pains must be spared in ascertaining, presenting, controlling and reducing costs. An effective system of Cost Accountancy and Cost Control is imperative for the survival of hospitals in the intensely competitive conditions of today. The valuable objective of "better patient care" can be attained only if the management can make use of the various tools and techniques to ascertain, control and reduce each item of cost in hospitals. Constant efforts must be made by the management to continuously improve their services and bring down costs and prices of all hospital services. Cost Accountancy has made its impresssive impact on almost all the spheres of human activities. It is high time a comprehensive Cost Accountancy and Cost Control system be implemented in hospitals. The problem under study thus is the designing of a sound and full-fledged Cost Accountancy and Cost Control system that suits the requirements of hospitals. It is for the first time in India during the evolution of Cost Accountancy that a comprehensive cost system is tried in hospitals.

Determinantes de la gesti��n cl��nica en atenci��n m��dica domiciliaria de personas con secuelas de enfermedad cerebro-vascular

La atenci��n domiciliaria constituye hoy una modalidad de atenci��n que permite solventar las dificultades derivadas de la sobreocupaci��n hospitalaria y la cronicidad, los cuales constituyen un problema de inter��s en salud p��blica en los pa��ses desarrollados y que pueden ser manejados en el domicilio del paciente como una opci��n costo-efectiva y segura. Para lo cual es necesario buscar estrategias que permitan su desarrollo, gesti��n de riesgos y modelos de atenci��n, logrando mejorar las condiciones de salud de la poblaci��n. Uno de los principales retos de la gesti��n de programas de atenci��n en salud, se encuentra en definir los aspectos donde intervenir para potenciar la eficacia y la calidad en la prestaci��n del servicio, por lo que dichos aspectos se constituyen como determinantes de la atenci��n del paciente y su familia. En este documento se abordan los principales determinantes en la atenci��n de personas con secuelas de Enfermedad cerebrovascular, que reciben manejo medico domiciliario, con el objetivo de identificar las ��reas prioritarias de intervenci��n, garantizando una mejor gesti��n cl��nica en tres ��reas espec��ficas: sobrecarga del cuidador, Polimedicaci��n y ulceras por dec��bito.

Factores que influyen en la actividad de trasplantes en Colombia a��o 2013. Desde la perspectiva de pacientes renales y de expertos en trasplante de ri����n, h��gado y coraz��n

Antecedentes: Se encuentran datos oficiales sobre trasplante de ��rganos en Colombia desde 2005 del Instituto Nacional de Salud y desde 2008 para ri����n por la Cuenta de Alto Costo. Los datos no ofrecen explicaci��n del n��mero de inscritos en lista de espera para trasplante renal, al comparar con otros pa��ses: Colombia 4,68% vs. Argentina 27,58% o Estados Unidos 21,73%. Por otra parte no existen datos acerca de factores que influyen en el seguimiento pos-trasplante y no se tienen de sobrevida del receptor y del injerto. Metodolog��a: Investigaci��n de metodolog��a mixta cuantitativa y cualitativa a partir de la informaci��n disponible en los informes oficiales y teniendo como fuente primaria pacientes y expertos en el cuidado de paciente antes y despu��s del trasplante. Resultados: Los factores para acceder o no a lista de espera y seguimiento m��s mencionados son sistema de salud, aspectos ��ticos en cuanto remisi��n y autorizaci��n. Emerge como categor��a la necesidad de un sistema de vigilancia en trasplantes. En la parte cuantitativa se trasplantan m��s personas si viven en una ciudad con grupo de trasplante 17,6 vs. 8,05%, si pertenecen al r��gimen contributivo O.R 3,37 p<0,00001, si no tienen diabetes O.R 3,22 p<0,0001 ni hipertensi��n arterial O.R 2,42 p<0,0001. No se encontr�� diferencia en cuanto a g��nero O.R 1,01 p 0,57. Conclusiones: Se proponen ajustes al sistema de salud, de la normatividad, de la educaci��n de la promoci��n de la donaci��n y trasplante en todos los niveles del p��blico y del personal de salud.

Medical Student���s Use of Time During Clinical Clerkships and the Credits Based System

Introduction: Comprehensive undergraduate education in clinical sciences is grounded on activities developed during clerkships. To implement the credits system we must know how these experiences take place. Objectives: to describe how students spend time in clerkships, how they assess the educative value of activities and the enjoyment it provides. Method: We distributed a form to a random clustered sample of a 100 students coursing clinical sciences, designed to record the time spent, and to assess the educative value and the grade of enjoyment of the activities in clerkship during a week. Data were registered and analyzed on Excel�� 98 and SPSS. Results: mean time spent by students in clerkship activities on a day were 10.8 hours. Of those, 7.3 hours (69%) were spent in formal education activities. Patient care activities with teachers occupied the major proportion of time (15.4%). Of the teaching and learning activities in a week, 28 hours (56%) were spent in patient care activities and 22.4 hours (44.5%) were used in independent academic work. The time spent in teaching and learning activities correspond to 19 credits of a semester of 18 weeks. The activities assessed as having the major educational value were homework activities (4.6) and formal education activities (4.5). The graded as most enjoyable were extracurricular activities, formal educational activities and independent academic work. Conclusion: our students spend more time in activities with patients than the reported in literature. The attending workload of our students is greater than the one reported in similar studies.

Psychological intervention in an only multifamily session at an Acute Care Unit of a psychiatric clinic

This article provides an overview of the psychological intervention in a Unit Care of Mental Health. The objectives and therapeutic actions to follow are defined through the participation of an interdisciplinary team and networking; it includes support groups and, especially, the families of patients that suffer a severe mental disorder. The materials and resources used were weekly sessions of one hour and forty minutes, for two years of monitoring (2005-2007). The study population consists of families of patients with different pathologies, which are in the Intensive Care Unit. In terms of design, it is made a qualitativeanalysis of 100 field day formats, and fills a matrix of content analysis. It is reviewed the objectives, the approach Multi-Focus, methodology, used techniques, the procedures developed and the feedback given at each session. The findings from this study show that mental disorders are related to the environment in which the patient is developed and complex social process. They also suggest a greater need for psychiatric patient care and its networks, timely and relevantly. By the other hand, it shows the importance of increasing efforts to make available in the field of mental health brief strategic interventions in interdisciplinary teams, it is appropriate a psycho educational and therapeutic approach in which the actions are coordinated at different levels.

Porque a compet��ncia pedag��gica conta : o refor��o do papel da avalia����o dos docentes na estrat��gia de desenvolvimento de um faculdade de medicina

���Poor teaching performance is tolerated, whereas poor quality in research or substandard patient care is not. It is time to professionalize teaching and education��� (Steinert, 2005). A Faculdade de Medicina da Universidade de Coimbra (FMUC) �� uma escola m��dica cl��ssica, sem qualquer tradi����o na avalia����o do ensino e com uma consider��vel resist��ncia �� introdu����o de mecanismos de auditoria de qualidade. Com o objectivo de contribuir para ultrapassar estas dificuldades, o regente da disciplina de Fisiopatologia, e membro do Departamento de Educa����o M��dica (DEM) da FMUC, aplicou um question��rio nessa disciplina. Este question��rio foi concebido para cobrir dimens��es relevantes na avalia����o da qualidade de ensino: objectivos; conte��dos; materiais; m��todos de ensino; instrumentos de avalia����o; apresenta����o e prepara����o da aula. Foi pedido aos alunos que respondessem ao question��rio no fim de cada aula te��rica e cada aula te��rico-pr��tica. Foi recolhido um total de 2401 question��rios (aulas te��ricas=1210; aulas te��rico-pr��ticas= 1191). Os resultados s��o discutidos em termos das suas implica����es para o desenvolvimento do pessoal docente, das pol��ticas da Escola e para a promo����o da qualidade de ensino, como uma contribui����o tendente ao estabelecimento de um clima institucional que encoraje a lideran��a educacional, a inova����o e a excel��ncia.

V��rd i livets slut av personer med demens. Personal och anh��rigas upplevelse av given v��rd : En metasyntes

Palliativt f��rh��llningss��tt k��nnetecknas av helhetssyn av m��nniskan och uppn��s genom st��ttning av individen att leva med v��rdighet och st��rsta m��jliga v��lbefinnande till livets slut oavsett diagnos eller ��lder. Demens ��r en sjukdom som ��r sv��rt handikappande f��r den som drabbas och f��r de anh��riga ��r sjukdomen f��r��dande. Den palliativa v��rden av personer med demens ��r inte optimerad. Studier visar att det dels beror p�� demenssjukdomen som ��r sv��r att v��rda och dels f��r att st��d till de personer som v��rdar sina anh��riga och det sociala kommunala n��tverket har brister. Syfte: Att analysera upplevelsen av given v��rd i livets slutskede hos personer med demensdiagnos ur personalens och anh��rigas perspektiv. Metod: Metasyntes utf��rd med Howell Major och Savin-Badins analysmodell, Qualitative Research Synthesis. Resultat: Kunskap och personcentrering var de tv�� begrepp som blev produkten av syntesen. Begreppen fungerar som motsatser, om det finns kunskap och personcentrering s�� finns en bra upplevelse av given v��rd hos personal och anh��riga och om det brister i kunskap och personcentrering blir upplevelsen s��mre. Diskussion: Kunskap om demens bland personal har i syntesen visats vara en indikator f��r god v��rd vid livets slut. Utbildning i demenssjukdom b��r ske kontinuerligt och p�� olika niv��er beroende p�� vilken personalkategori som utbildas. Konklusion: Palliativ v��rd och demens m��ste f�� utrymme i utbildningarna av all personal, fr��n undersk��terska till specialistl��kare.

Kvalitetsuppf��ljningar och sjuksk��terskans omv��rdnadsprioriteringar i s��rskilt boende : En kvalitativ intervjustudie

Syfte: Att unders��ka hur sjuksk��terskor inom s��rskilt boende resonerar kring kvalitetsuppf��ljningar och dess eventuella konsekvenser f��r omv��rdnaden. Metod: Semistrukturerade intervjuer efter ��ppen intervjuguide med sex sjuksk��terskor. Kvalitativ inneh��llsanalys enligt Graneheim och Lundmans metod. Huvudresultat: I vilken grad kvalitetsregistren och kvalitetsuppf��ljningarna integreras i omv��rdnadsarbetet och dess utveckling ��r centralt f��r om dessa uppfattas som st��d eller hinder f��r god kvalit�� i omv��rdnaden. Dubbel dokumentation bidrar till att sjuksk��terskorna omprioriterar arbetstiden och arbetar mer konsultativt och administrativt. Detta minskar tiden f��r omv��rdnadsobservationer och handleding av omv��rdnadspersonal samt g��r att kvalitetsregistreringar snarast uppfattas som ett hinder. Sjuksk��terskorna anv��nde sin professionella kunskap och kliniska erfarenhet i h��gre grad ��n registerdata vid omv��rdnadsbed��mningar. Dessa s��gs som alltf��r komplexa f��r att kunna f��ngas i kryssfr��geformul��r. Mer kliniska observationer efterfr��gas i kvalitetsuppf��ljningarna f��r ��kad medvetenhet om h��g arbetsbelastning och dess eventuella konsekvenser samt f��r att garantera de boende god omv��rdnadskvalit��. Konklusion: Sjuksk��terskorna upplever att de arbetar under sv��r tidspress. Tiden anges som essentiell f��r vilken omv��rdnadskvalit�� som erbjuds. Vid beslut om registreringar av kvalitetsindikatorer b��r sjuksk��terskornas totala arbetsb��rda beaktas. Registreringarna b��r integreras i befintliga journalsystem s�� att sjuksk��terskornas omprioriteringar inte f��r negativa konsekvenser f��r omv��rdnadskvaliten.

Pregnant Adolescents in Vietnam : Social context and health care needs

Background: The number of childbearing adolescents in Vietnam is relatively low but they are more prone to experience adverse outcome than adult women. Reports of increasing rates of abortion and prevalence of STIs including HIV among youth indicate a need to improve services and counselling for these groups. Midwives are key persons in the promotion of young people���s sexual and reproductive health in Vietnam. Aim: The overall aim of this thesis is to describe the prevalence and outcome of adolescent pregnancies in Vietnam (I), to explore the social context and health care seeking behavior of pregnant adolescents (II), as well as to explore the perspectives of health care providers and midwifery students regarding adolescent sexuality and reproductive health service needs (III, IV). Methods: The studies were conducted from 2002 to 2005, combining qualitative and quantitative research methods. A population based prospective survey was used to estimate rates and outcomes of adolescent pregnancies (I). Pregnant and newly delivered adolescents��� experiences of childbearing and their encounters with health care providers were studied using qualitative interviews (II). Health care providers��� perspective on adolescent sexual and reproductive health (ASRH) and views on how to improve the quality of abortion care was explored in focus group discussions (FGD). The values and attitudes of midwifery students about ASRH were investigated using questionnaires and interviews (IV). Descriptive statistics was used to analyse quantitative data (I, IV) and content analysis were applied for qualitative data (II, III, and IV). Findings: Adolescent birth rate was similar to previously reported in Vietnam but lower when compared to other Asian countries. The incidence of stillborn among adolescents was higher than for women in higher reproductive ages. The proportion of preterm deliveries was 20 % of all births, higher than previous findings from Vietnam. About 2 % of the deliveries were home deliveries, more common among women with low education, belonging to ethnic minority and/or living in mountainous areas (I). Ambivalence facing motherhood, pride and happiness but also worries and lack of self-confidence emerged as themes from the interviews; and experience of ���being in the hands of others��� in a positive, caring sense but also in a sense of subordination in relation to husband, family and health care providers (II). Health care providers at abortion clinics and midwifery students generally disapproved of pre-marital sex, but had a pragmatic view on the need for contraceptive services and counselling to reduce the burden of unwanted pregnancies and abortions for young women. Providers and midwifery students expressed a need for training on ASRH issues (III, IV). Conclusion: Cultural norms and gender inequity make pregnant adolescent women in Vietnam vulnerable to sexual and reproductive health risks. Health care providers experience ethical dilemmas while counselling unmarried adolescents who come for abortion and this has a negative impact on the quality of care. Integrated ASRH in education and training programmes for health care providers, including midwives, as well as continued in-service training on these issues are suggested to improve reproductive health care services in Vietnam.

Distriktssk��terskors upplevelser och erfarenheter av patientundervisning till personer med diabetes ��� utifr��n ett personcentrerat f��rh��llningss��tt : En kvalitativ studie

Syfte: Syftet med studien var att beskriva distriktssk��terskors upplevelser och erfarenheter av patientundervisning till patienter med diabetes samt att identifiera aspekter som kan relateras till ett personcentrerat f��rh��llningss��tt. Metod: Deskriptiv design med kvalitativ ansats med semistrukturerade intervjuer anv��ndes vid datainsamlingen. Vid urvalet anv��ndes strategiskt urval. Nio intervjuer utf��rdes med distriktssk��terskor p�� sex olika v��rdcentraler i Mellansverige. Vid analysen anv��ndes kvalitativ inneh��llsanalys. Resultat: Distriktssk��terskorna ��nskade mer kunskap om invandrares kost- och motionsvanor. Distriktssk��terskorna uttryckte att det var roligt och sp��nnande med patientundervisning och att det var viktigt att de var engagerade. Distriktssk��terskorna ville arbeta mer i team och de upplevde att de hade f��r lite tid avsatt f��r patientundervisning. De ans��g att de arbetade personcentrerat men det var sv��rare att arbeta personcentrerat vid gruppundervisning ��n vid enskild undervisning. Slutsats: Distriktssk��terskor b��r ha god kunskap om kulturella skillnader hos patienter med diabetes. Distriktssk��terskorna upplever brist p�� tid- och resurser och ��nskar samarbeta mera i team. Det ��r viktigt med ett personcentrerat f��rh��llningss��tt d��r distriktssk��terskorna utg��r fr��n den enskilda individen. En distriktssk��terska som ��r engagerad och trivs med sitt arbete kan l��ttare klara av det ��kade trycket och arbetsbelastningen.

Saberes de enfermeiros acerca do processo de enfermagem �� luz do modelo conceitual de Wanda de Aguiar Horta

Objetivou-se caracterizar os saberes de enfermeiros sobre o Processo de Enfermagem. M��todos: Trata-se de um estudo qualitativo de natureza explorat��rio-descritivo, efetivado nos meses de agosto de 2010 a junho de 2011 com 12 enfermeiros atuantes da Estrat��gia de Sa��de da Fam��lia da cidade de Juazeiro do Norte-Cear��. Aplicou-se uma entrevista atrav��s de um roteiro semiestruturado ap��s a assinatura do termo de anu��ncia pelos participantes. Resultados: Os enfermeiros percebem o Processo de Enfermagem como uma ferramenta tecnol��gica que permite a oferta de uma assist��ncia de enfermagem sistem��tica, racional e planejada, tendo em vista o reconhecimento e atendimento das necessidades humanas b��sicas do ser cuidado. Conclus��o: Portanto, os enfermeiros det��m uma convic����o clara acerca da significa����o do Processo de Enfermagem e sua capacidade de satisfazer as demandas de cuidado do indiv��duo, fam��lia e comunidade

Um estudo sobre o est��gio supervisionado na forma����o inicial de professores de matem��tica na Bahia

This work arose from our concerns with the issues of teacher training for early childhood education. From the difficulties encountered as a novice teacher in elementary, we deem important to research training needs of these professionals. Thus, we define the objective of this research to investigate the training needs of novice teachers teaching Early Childhood Education/Elementary school. Our work fits in Educational Research Qualitative Approach, and its construction procedures of the semistructured interview data and document analysis. Our empirical field was made up of schools in the metropolitan region of Natal / RN, offering kindergarten / elementary school. The subjects are five teachers who act as holder of the elementary school class and have 0-3 years of teaching practice, characterizing the second Huberman (2007) as novice teachers. Data analysis, based on principles of content analysis, three themes emerged: Beginner Teaching Professor in Early Childhood Education / Preschool; Reasons explaining the difficulties Faculty / Formative Needs Teaching and Training in Early Childhood Education / Elementary school, from the Training Needs Analysis, with their respective categories, subcategories, contributing to our understanding of the subject matter. The entry into the profession is marked by mixed feelings of euphoria and fear, where there seems to be a "clash" with reality. The difficulties are related to the planning / execution of activities, meet the individual needs of learning and assessment of children. As a strategy to overcome the difficulties the teachers exercise the action-reflection-action in their practices and seek continuous updates in the theoretical and methodological framework of early childhood education. The reasons that define these difficulties may be related to the teacher, school, family, and students of these institutions. In experiencing these difficulties has outlined the need for teacher training, among which stand out studies on ethics in teaching with children, the concept of children and their childhoods, peculiarities of teaching / learning in preschool, toys and legal determinations on early childhood education, multi-language and expressions in early childhood education, specific content areas of knowledge, among others. Furthermore, studies on the theoretical as Piaget, Vigotsky, Maria Carmen Barbosa and Emily Smith. For these professionals to be a professional early childhood education is: like children, be patient and careful, have specific theoretical and practical training for teachers in kindergarten, being able to improvise with seriousness and competence and get updates on continuing education. The surveys, together with the authors and teachers, to confirm our understanding that the training needs of beginners may be related to shortcomings in the initial and continuing education

A forma����o do enfermeiro na reflexividade

The study proposes an understanding of nurses training in reflexivity and the overcome the limits of biomedical formation model, from the thought of John Dewey, inserted in the panorama of the reflective practitioner introduced by Donald Sch��n and dialoguing with the perspective of the transforming action of Paulo Freire. We used a qualitative approach to collect empirical data through focus groups conducted with nursing students from 3rd to 5th year in the Faculty of Health Sciences, Trairi / UFRN in the year 2012. Data analysis occurred through the technique of thematic content analysis constituted of three stages: pre-analysis, exploration of the material, treatment of results, inference and interpretation of the material. Thus, the categories formulated by organizing, classifying and aggregating the the content of the speeches to groups who shared opinions approximations of thought generating a set of categories of analysis designed from the contents. The results present the experiences of nursing students and their reflections, demonstrating that the process of reflection permeates the journey of life. It is inferred that the knowledge acquired in these experiences do not always participate in this dialogue in this formative process, reducing previous experiences in the field of exemplification of everyday situations. We conclude that it is necessary to consolidate innovative pedagogical proposals that allow the continuous dialogue with reality, breaking with the decontextualized teaching process from reality insertion of the university. Rethinking of the structures is recommended, reinforcing the break with the biomedical model and the integration of knowledge dynamically