Avaliação da cultura de segurança do doente em meio hospitalar : investigação ação numa unidade de radioterapia

RESUMO Introdução e objetivos As organizações internacionais responsáveis pela Qualidade na Saúde e Segurança do doente (Organização Mundial da Saúde, União Europeia), recomendam aos Estados membros a avaliação da cultura de segurança, como condição essencial para se introduzir mudanças nos comportamentos dos profissionais e nas organizações prestadoras de cuidados de saúde, e alcançar melhores níveis de segurança e de qualidade nos cuidados de saúde prestados aos doentes. Constitui objetivo geral deste trabalho contribuir para a implementação da cultura de segurança do doente nos profissionais envolvidos na prestação de cuidados de saúde, concorrendo para a avaliação da cultura de segurança do doente e, consequentemente para a garantia da qualidade dos cuidados prestados. Metodologia 1ª fase – pré-estudo: através da revisão de literatura identificamos o instrumento mais adequado para avaliar a cultura de segurança do hospital, traduzimos e validámos o instrumento. 2ª fase – desenvolvemos um estudo exploratório-descritivo, transversal, retrospetivo, em 3 hospitais portugueses e um estudo exploratório-descritivo, longitudinal, prospetivo, de investigação-ação, numa unidade de radioterapia. Resultados O Hospital Survey on Patient Safety Culture é o instrumento que revela as adequadas características para a avaliação da cultura de segurança nos hospitais portugueses. No que diz respeito à avaliação da cultura de segurança em três hospitais portugueses, podemos destacar que o trabalho em equipa, a expectativas do supervisor e a aprendizagem organizacional são as dimensões com melhores resultados apesar da frequência das notificações e das respostas ao erro não punitivas apresentarem os piores resultados. Verificou-se que a URT se encontra em franca evolução, o que se torna visível sobretudo na adesão à notificação que aumentou à medida que o tempo foi passando. O envolvimento de todos no desenho da intervenção e nas atividades a decorrer na unidade, foi preponderante para a melhoria da segurança do doente. Conclusões Temos consciência que existem muitas questões por responder e que na realidade não há receitas nem diretrizes que possam afirmar que existem relações de causalidade, confrontando uma determinada ação com a consequente mudança cultural. No entanto, estamos convictos que o envolvimento de todos os membros da organização/unidade, o compromisso forte da liderança, uma comunicação efetiva e uma notificação não punitiva são ingredientes essenciais para a melhoria contínua da cultura de segurança do doente.

Personal advisors for business professionals: improving communication skills with online corpora

The business sphere is a multilingual world where foreign language communication skills are crucial in international relations. It makes employers look for business professionals who have a high level of linguistic competences. Language proficiency increases the chances of negotiation among partners. There are mainly two obstacles that make barriers in formal communication in a foreign language: lack of knowledge of specific linguistic structures or terminology and frequent transitions from one language to another. This paper contributes to the quest for quick access to a wide range of English, Spanish and Russian online databases that provide authentic language samples. Their application may improve communication skills and facilitate preparation for business discourse.

On an organizational level: How can the emergency department at Rouge Valley Centenary hospital improve their wait times?

The prolonged wait times may arguably put into question the Canadian Health Act of 1984. Statistics show throughput wait times are 5.5 hours and output wait times for admitted patients are 32.4 hours. After probing and analyzing best practices through a qualitative/quantitative Value Stream Mapping and a qualitative SWOT Analysis; Team Triage and an Overcapacity Protocol is suggested to improve non-admitted patients wait times by 1.89 hours and admitted patients wait times by 16 hours by eliminating wasteful steps in the patient process and upon overcapacity, effectively sharing already stabilized and admitted patients with all wards in the hospital.

(Un)ethical leadership, organizational identification and sensemaking: the BES case and its impact on employees

This paper provides an ongoing analysis to one of the biggest ethical and financial scandals in Portugal – Banco Espírito Santo (BES). BES was considered one of the three best banks but it went bankrupted and its employees were transferred to a new entity – Novo Banco. This study was conducted in order to provide an understanding of the employees’ side, which has been forgotten so far. An ethical scandal (sensebreaking) creates ambiguity and uncertainty which triggers new sensemaking processes in order to understand and derive meaning from the new reality. The methodology followed was semi-structured interviews to employees both from the branches and the central services. We found evidence that in organizations with strong identification, unethical behavior has a significant impact on followers’ – the new process of sensemaking is particularly important in this situation because employees suffer more from the disruption of their reality.

Ethical leadership and unethical pro-organizational behavior: A moderated mediation model of affective commitment and authenticity at work

Recently, unethical conduct in the workplace has been a focus of literature and media. Unethical pro-organizational behavior (UPB) refers to unethical conduct that employees engage in to benefit the organization. Given the complexity of UPB, there is an increasing need to understand how and under what conditions this attitude originates within organizations. Based on a sample of 167 employees and seven organizations, results support the moderated mediation model. An ethical leader increases employees’ organizational affective commitment which increases the likelihood to engage in UPB. However, the indirect relationship diminishes when employees feel authentic at work.

How to promote and enhance communication between a big retailer's after-sales department and its suppliers

W is the biggest electronic goods retailer in Portugal accounting with almost fifty percent of market share in its area. During the last years, many small W suppliers had to close their doors, and many others are in huge troubles. Among the reason for this situation, the huge bargaining power of W in the relationship seems crucial. The focus of the directed research will be in the after sales department where I did an internship from September 2014 to January 2015.

Leadership in Angola and Mozambique: How Portuguese leaders overcome the human resources challenge and contribute to organizational success

This Work Project presents human resources as one of the major challenges that Portuguese leaders meet in Angola and Mozambique. The main goal is to understand the role of leaders in translating this challenge into benefits for their own business and the African society. To conduct this study 13 leaders who work in Portugal and Africa were interviewed. Then, a framework was constructed based on the two ways these leaders recognize the importance of their employees for sustainable growth – financial incentives or/and personal development. The main conclusion here is that individually, incentives and personal development are not effective methods. Because of this, an employee empowerment process is proposed that encloses both, along with the leaders’ personal qualities needed to implement that “ideal” process.

Using an LED as a sensor and visible light communication device in a smart illumination system

The need for more efficient illumination systems has led to the proliferation of Solid-State Lighting (SSL) systems, which offer optimized power consumption. SSL systems are comprised of LED devices which are intrinsically fast devices and permit very fast light modulation. This, along with the congestion of the radio frequency spectrum has paved the path for the emergence of Visible Light Communication (VLC) systems. VLC uses free space to convey information by using light modulation. Notwithstanding, as VLC systems proliferate and cost competitiveness ensues, there are two important aspects to be considered. State-of-the-art VLC implementations use power demanding PAs, and thus it is important to investigate if regular, existent Switched-Mode Power Supply (SMPS) circuits can be adapted for VLC use. A 28 W buck regulator was implemented using a off-the-shelf LED Driver integrated circuit, using both series and parallel dimming techniques. Results show that optical clock frequencies up to 500 kHz are achievable without any major modification besides adequate component sizing. The use of an LED as a sensor was investigated, in a short-range, low-data-rate perspective. Results show successful communication in an LED-to-LED configuration, with enhanced range when using LED strings as sensors. Besides, LEDs present spectral selective sensitivity, which makes them good contenders for a multi-colour LED-to-LED system, such as in the use of RGB displays and lamps. Ultimately, the present work shows evidence that LEDs can be used as a dual-purpose device, enabling not only illumination, but also bi-directional data communication.

Multipacket reception in the presence of in-band full-duplex communication

In-Band Full-DupleX (IB-FDX) is defined as the ability for nodes to transmit and receive signals simultaneously on the same channel. Conventional digital wireless networks do not implement it, since a node’s own transmission signal causes interference to the signal it is trying to receive. However, recent studies attempt to overcome this obstacle, since it can potentially double the spectral efficiency of current wireless networks. Different mechanisms exist today that are able to reduce a significant part of the Self- Interference (SI), although specially tuned Medium Access Control (MAC) protocols are required to optimize its use. One of IB-FDX’s biggest problems is that the nodes’ interference range is extended, meaning the unusable space for other transmissions and receptions is broader. This dissertation proposes using MultiPacket Reception (MPR) to address this issue and adapts an already existing Single-Carrier with Frequency-Domain Equalization (SC-FDE) receiver to IB-FDX. The performance analysis suggests that MPR and IB-FDX have a strong synergy and are able to achieve higher data rates, when used together. Using analytical models, the optimal transmission patterns and transmission power were identified, which maximize the channel capacity with the minimal energy consumption. This was used to define a new MAC protocol, named Full-duplex Multipacket reception Medium Access Control (FM-MAC). FM-MAC was designed for a single-hop cellular infrastructure, where the Access Point (AP) and the terminals implement both IB-FDX and MPR. It divides the coverage range of the AP into a closer Full-DupleX (FDX) zone and a farther Half-DupleX (HDX) zone and adds a tunable fairness mechanism to avoid terminal starvation. Simulation results show that this protocol provides efficient support for both HDX and FDX terminals, maximizing its capacity when more FDX terminals are used.

Non-cell autonomous neuroprotective effect of carbon monoxide : microglia-to-neuron communication

RESUMO: A isquémia cerebral é uma das doenças mais predominantes a nivel mundial, sendo uma das principais causas de mortalidade e invalidez. Parte da propagação de dano no cérebro é causado por inflamação descontrolada, causada principalmente por disfunção da microglia. Desta forma, existe a necessidade de tentar desenvolver estratégias para melhor compreender e modular as acções destas células. O monóxido de carbono (CO), é uma molécula endógena com provas dadas como anti-neuroinflamatório em vários modelos. Assim, o principal objectivo do trabalho foi o estudo do CO como um modulador da acção da microglia, com principal foco dado à comunicação entre estas células e neurónios, tentando entender se existe um efeito neuroprotector por inibição da inflamação. Um protocolo de meio condicionado foi estabelecido usando as linhas celulares BV2 e SH-SY5Y, de microglia e neurónio. A molécula CORM-A1, que liberta expontaniamente CO, foi usada como método de entrega da molécula às celulas. Demonstrámos que o pre-tratamento de células BV2 com CORM-A1 gera neuroprotecção já que reduz a morte celular de neurónios SH-SY5Y quando são incubados com meio condicionado de microglia activada em conjunto com o pró-oxidante t-BHP (tert-butil hidroperóxido). Assim, considerámos que o CO promove neuroprotecção ao inibir as acções inflamatórias da microglia. O papel anti-inflamatório da molécula CORM-A1 foi confirmado quando se verificou que pré-tratamento desta molécula em microglia BV2 limita a secreção de TNF-α mas estimula a secreção de IL-10. Por último, a CORM-A1 induziu a expressão do receptor da microglia CD200R1, molécula que participa na comunicação neurónio-microglia e fundamental para a modulação das acções inflamatórias destas últimas. Em suma, o nosso trabalho reforçou as propriedades anti-neuroinflamatórias do CO e uma capacidade de modular viabilidade neuronal através do seu efeito a nível de comunicação célula-célula. ---------------------------- ABSTRACT: Brain ischemia is a widespread disease worldwide, being one of the main causes of mortality and permanent disability. A portion of the damage that ensues following the ischemic event is caused by unrestrained inflammation, which is mainly orchestrated by exacerbated microglial activity. Hence, developing strategies for modulating microglial inflammation is a major concern nowadays. The endogenous molecule carbon monoxide (CO) has been shown to possess anti-neuroinflammatory properties using in vitro and in vivo approaches. Thus, our objective was to study CO as modulator of microglial activity, in particular in what concerns their communication with neurons, by promoting neuronal viability and limiting inflammatory output of activated microglia. A conditioned media strategy was established with BV2 microglia and SH-SY5Y neurons as cell models. CO-releasing molecule A1 (CORM-A1), a compound that releases CO spontaneously, was used as method of CO delivery to cells. We found that CORM-A1 pre-treatment in BV2 cells yields neuroprotective results, as it limits cell death when SH-SY5Y neurons are challenged with conditioned media from LPS-activated microglia and the pro-oxidant t-BHP (tert-butyl-hydroperoxide). Thus, we assumed carbon monoxide promotes neuroprotection via inhibition of microglial inflammation, displaying a non-cell autonomous role. CORM-A1 pre-treatment limited inflammation by inhibiting BV2 secretion of TNF-α and stimulating IL-10 production. These results reinforce that CO’s anti-inflammatory role confers neuroprotection, as the alterations in these cytokines occur concurrently with the increase in SH-SY5Y viability. Finally, we showed for the first time that carbon monoxide promotes the expression of CD200R1, a microglial receptor involved in neuron-glia communication and modulation of microglia inflammation. Further studies are necessary to clarify this role. Altogether, other than just highlighting CO as an anti-inflammatory and neuroprotective molecule, this work set the foundation for disclosing its involvement in cell-to-cell communication.

Ethical leadership and reputation: Combined indirect effects on organizational deviance

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Journal of Business Ethics following peer review. The version of record Neves, P., & Story, J. (2015). Ethical Leadership and Reputation: Combined Indirect Effects on Organizational Deviance. Journal of Business Ethics, 127(1), 165–176. “The final publication is available at Springer via http://dx.doi.org/10.1007/s10551-013-1997-3”.

Which communication strategy should a male luxury (fashion) brand – associated with a luxury car brand – develop, in order to increase its awareness in Europe

This work project explores how a male luxury (fashion) brand (subsidiary) that is associated with a luxury car brand (parent company) should develop its communication strategy in order to increase awareness in Europe. For this purpose a quantitative research was conducted. The aim was to find out whether the company in question had low brand awareness among European luxury consumers. Hereafter, a qualitative research revealed important insights in regard to luxury communication among male luxury consumers. Both the results of the research and the recommendations of luxury experts laid the foundation for the development of a solution-oriented communication strategy. The result of the analysis crystallizes the importance of the shared heritage and the synergistic effects, of which the subsidiary should make vast use when communicating.

Methodology for WSN communication technologies automated field tests

Wireless Sensor Networks(WSN) are networks of devices used to sense and act that applies wireless radios to communicate. To achieve a successful implementation of a wireless device it is necessary to take in consideration the existence of a wide variety of radios available, a large number of communication parameters (payload, duty cycle, etc.) and environmental conditions that may affect the device’s behaviour. However, to evaluate a specific radio towards a unique application it might be necessary to conduct trial experiments, with such a vast amount of devices, communication parameters and environmental conditions to take into consideration the number of trial cases generated can be surprisingly high. Thus, making trial experiments to achieve manual validation of wireless communication technologies becomes unsuitable due to the existence of a high number of trial cases on the field. To overcome this technological issue an automated test methodology was introduced, presenting the possibility to acquire data regarding the device’s behaviour when testing several technologies and parameters that care for a specific analysis. Therefore, this method advances the validation and analysis process of the wireless radios and allows the validation to be done without the need of specific and in depth knowledge about wireless devices.