A Component Based Heuristic Search Method with AdaptivePerturbations for Hospital Personnel Scheduling

Nurse rostering is a complex scheduling problem that affects hospital personnel on a daily basis all over the world. This paper presents a new component-based approach with adaptive perturbations, for a nurse scheduling problem arising at a major UK hospital. The main idea behind this technique is to decompose a schedule into its components (i.e. the allocated shift pattern of each nurse), and then mimic a natural evolutionary process on these components to iteratively deliver better schedules. The worthiness of all components in the schedule has to be continuously demonstrated in order for them to remain there. This demonstration employs a dynamic evaluation function which evaluates how well each component contributes towards the final objective. Two perturbation steps are then applied: the first perturbation eliminates a number of components that are deemed not worthy to stay in the current schedule; the second perturbation may also throw out, with a low level of probability, some worthy components. The eliminated components are replenished with new ones using a set of constructive heuristics using local optimality criteria. Computational results using 52 data instances demonstrate the applicability of the proposed approach in solving real-world problems.

Social representations of nursing students about hospital assistance and primary health care

Objective: To analyze how social representations of hospital and community care are structured in two groups of nursing students – 1st and 4th years. Method: Qualitative research oriented by the Theory of Social Representations. We used a questionnaire with Free Association of Words. Data were analyzed in the Software IRaMuTeQ 0.6 alpha 3. Results: We applied the method of Descending Hierarchical Classifi cation and obtained four classes. Class 4 has the largest social representation (30.41%) within the corpus. The two organizational axes are nurse and disease/patient in the central core. On the periphery are the care and help related to the nurse and the treatment and prevention associated with the disease. Conclusion: Social representations focus on disease/patient and on the role of nurses in the treatment, prevention, and care. Health promotion and the social determinants of health are absent from the social representations of students.

Satisfacción de la atención médica en el área del hospitalización del Departamento Gíneco -Obstetricia del Hospital José Carrasco Arteaga. 2014

Objetivo. Determinar el grado de satisfacción de las pacientes con la atención médica y de enfermería recibida en el Área de Hospitalización del Departamento de Gineco - Obstetricia del Hospital José Carrasco Arteaga. Metodología. Con un diseño descriptivo de corte transversal se recopiló información de 628 pacientes ingresadas a los servicios de Ginecología y Obstetricia entre marzo y mayo del 2014. Se analizó edad, instrucción, estado civil, residencia, diagnóstico al ingreso, al egreso y procedimiento realizado en los dos servicios y grado de satisfacción de las pacientes con el personal médico y el personal de enfermería. Resultados. Las pacientes del servicio de Ginecología representaron el 26.11 %, con un promedio de edad de 41.46 ± 11.41 años y las de Obstetricia el 73.89 % con una edad media de 28.62 ± 6.12 años. La instrucción más frecuente fue la secundaria, en la mayoría casadas y residen en el área urbana. El diagnóstico ginecológico más frecuente al ingreso y al egreso fue la hiperplasia endometrial con el 26.1 % en ambos casos. En el área Obstétrica, el embarazo a término sin complicaciones representó más del 50% de los diagnósticos tanto al ingreso como al egreso. La histerectomía fue el procedimiento ginecológico realizado con mayor frecuencia (25 %). La cesárea es el procedimiento obstétrico más frecuente (45.26 %). Conclusiones. Se obtienen valoraciones altas en la satisfacción de la atención médica en más del 65 % de las pacientes encuestadas tanto del personal médico como del personal de enfermería.

Satisfação dos utentes de uma unidade de cirurgia de ambulatório de um hospital central : contributo para melhor cuidar

Enquadramento: O carácter inovador da Cirurgia de Ambulatório reside no seu modelo organizativo específico, centrado no doente, que o envolve num circuito independente do de internamento, procurando-se ganhos em eficiência e em qualidade e obtendo-se níveis de maior humanização e satisfação dos utentes e seus familiares. Objetivos: Analisar de que forma as variáveis sociodemográficos influenciam a qualidade percebida dos utentes de uma Unidade de Cirurgia de Ambulatório de um Hospitalar Central; verificar se existem efeitos significativos das variáveis circunstanciais na qualidade percebida dos utentes de uma Unidade de Cirurgia de Ambulatório de um Hospitalar Central; verificar a existência de efeitos significativos das variáveis sociofamiliares na qualidade percebida nos utentes. Métodos: Estudo quantitativo, com corte transversal, descritivo e correlacional; enquadra-se num estudo descritivo analítico-correlacional porque o mesmo tem por objetivo explorar as relações entre variáveis e descrevê-las. Os dados foram colhidos junto dos utentes tendo como base escalas e questionários. A amostra é não probabilística por conveniência, constituída por 140 utentes de uma Unidade de Cirurgia de Ambulatório de um Hospitalar Central, na maioria, do sexo masculino (60,7%), com uma idade mínima de 19 anos e uma máxima de 94 anos, ao que corresponde uma idade média de 58,01 (±19.26 anos). Foi aplicado um Questionário de caracterização sociodemográfica e sociofamiliar, incluindo-se o Questionário (Medical Outcomes Study Social Support Survey) MOS-SSS (Fachado et al., 2007) e o Questionário Service Quality (SERVQUAL) (Parasuraman et al., 1988). Resultados: Os utentes do sexo feminino manifestam mais satisfação em relação à UCA (cortesia/empatia p=0.000; compreensão do utente p=0.000; fiabilidade p=0.005; acessibilidade p=0.010; qualidade global p=0.001; os utentes idosos obtiveram valores mais elevados em quase todas as dimensões e na qualidade global (aspetos físicos p=0.006); os participantes com o ensino básico manifestaram mais satisfação (fiabilidade p<0,016); os que possuem um rendimento familiar até 1000€ apresentaram maior nível de satisfação (cortesia/empatia p=0,033); os utentes que não se deslocam em meio de transporte próprio atribuem mais qualidade à UCA (fiabilidade p=0,028); aqueles cuja residência está situada a uma distância superior a 15 km do hospital revelam índices mais elevados de qualidade (cortesia/simpatia p=0.037; compreensão do utente p=0.044; fiabilidade p=0.022; acessibilidade p=0.001; qualidade global p=0.013); os participantes cuja distância de casa ao centro de saúde é superior a 9 km revelam mais satisfação (fiabilidade p=0.038); os utentes com tempos de espera para a cirurgia entre 6-12 meses atribuem mais qualidade à UCA (cortesia/empatia p=0.000; compreensão do utente p=0.011; fiabilidade p=0.007; acessibilidade p=0.001; qualidade global p=0.001). Conclusão: A maioria dos utentes atribui qualidade à UCA, tendo em conta a cortesia/empatia, a compreensão do utente, fiabilidade, acessibilidade e aspetos físicos, pode afirmar-se que a referida Unidade adequa os serviços prestados às suas necessidades, garantindo, deste modo, a satisfação dos utentes. Palavras-chave: Cirurgia de Ambulatório; Satisfação dos utentes; Qualidade; Atendimento.

Prevalence, types and factors associated with echocardiographic abnormalities among newly diagnosed diabetic patients at Mulago Hospital.

Background: The prevalence of Diabetes mellitus (DM) is on a rise in sub-Saharan Africa and will more than double by 2025. Cardiovascular disease (CVD) accounts for up to 2/3 of all deaths in the diabetic population. Of all the CVD deaths in DM, 3/4 occur in sub Saharan Africa (SSA). Non invasive identification of cardiac abnormalities, such as Left Ventricular Hypertrophy (LVH), diastolic and systolic dysfunction, is not part of diabetes complications surveillance programs in Uganda and there is limited data on this problem. This study sought to determine the prevalence, types and factors associated with echocardiographic abnormalities among newly diagnosed diabetic patients at Mulago National referral hospital in Uganda. Methods: In this cross sectional study conducted between June 2014 and December 2014, we recruited 202 newly diagnosed adult diabetic patients. Information on patients\' socio-demographics, bio-physical profile, biochemical testing and echocardiographic findings was obtained for all the participants using a pre-tested questionnaire. An abnormal echocardiogram in this study was defined as the presence of LVH, diastolic and/or systolic dysfunction and wall motion abnormality. Bivariate and multivariate logistic regression analyses were used to investigate the association of several parameters with echocardiographic abnormalities. Results: Of the 202 patients recruited, males were 102(50.5%) and the mean age was 46±15 years. Majority of patients had type 2 DM, 156(77.2%) and type 1 DM, 41(20.3%) with mean HbA1C of 13.9±5.3%. Mean duration of diabetes was 2 months. The prevalence of an abnormal echocardiogram was 67.8 % (95% CI 60%-74%). Diastolic dysfunction, systolic dysfunction, LVH and wall motion abnormalities were present in 55.0%, 21.8%, 19.3% and 4.0% of all the participants respectively. In bivariate logistic regression analysis, the factors associated with an abnormal echocardiogram were age (OR 1.09 [95% CI 1.06–1.12], P <0.0001), type 2 DM (OR 5.8[95% CI 2.77-12.07], P<0.0001), hypertension (OR 2.64[95% CI 1.44-4.85], P=0.002), obesity (OR 3.51[955 CI 1.25-9.84], P=0.017 and increased waist circumference (OR 1.02[95% CI 1.00-1.04], P=0.024. On Multiple logistic regression analysis, age was the only factor associated with an abnormal echocardiogram (OR 1.09[95%CI 1.05-1.15], P<0.0001). Conclusion: Echocardiographic abnormalities were common among newly diagnosed adults with DM. Traditional CVD risk factors were associated with an abnormal echocardiogram in this patient population. Due to a high prevalence of echocardiographic abnormalities among newly diagnosed diabetics, we recommend screening for cardiac disease especially in patients who present with traditional CVD risk factors. This will facilitate early diagnosis, management and hence better patient outcomes.

Malnutrition in pre-dialysis chronic kidney disease patients in a teaching hospital in Southern Nigeria.

Background: Malnutrition is a complication in chronic kidney disease (CKD) known to affect quality of life and prognosis although not often diagnosed. It is associated with rapid progression to end stage renal disease (ESRD) and mortality. Early identification and treatment will slow down progression to ESRD and mortality. Objective: To determine the prevalence and pattern of malnutrition in pre-dialysis CKD patients in Southern Nigeria. Methods: One hundred and twenty consecutive pre-dialysis CKD and 40 control subjects without CKD were studied. Data obtained from participants were demographics, body mass index (BMI), and aetiology of CKD. Indices used to assess presence of malnutrition were low BMI, hypocholesterolaemia and hypoalbuminaemia. Statistical significance was taken at 0.05 level. Results: The mean age of the CKD subjects was 48.8±16.6years with a male: female ratio of 1.7:1. Prevalence of malnutrition in the CKD subjects was 46.7%, higher than 27.5% observed in the controls (p=0.033). Prevalence of malnutrition increased significantly across CKD stages 2 to 5 (p=0.020). It was significantly commoner in elderly patients (p=0.047) but not significantly different between males and females(p=0.188). Conclusion: Malnutrition is common in pre-dialysis CKD patients even in early CKD stages. Prevalence of malnutrition increases with worsening kidney function and increasing age.

Ear-related problems among children attending the paediatric and otorhinolaryngology out-patients clinics of the University of Nigeria Teaching Hospital, Enugu.

Background: Ear related diseases are commonly seen in clinics worldwide especially among children. They are associated with significant morbidity and frequent hospital visits. Limited data exists regarding the burden of ear disease among Nigerian children. Objective: To determine the prevalence of ear-related problems among children presenting at the Paediatric and Otorhinolaryngology clinics of the University of Nigeria Teaching Hospital, Enugu. Materials and methods: This was a cross-sectional study conducted at the Paediatric and Otorhinolaryngology Clinics of the University of Nigeria Teaching Hospital Enugu. All children aged 0 and 17 years presenting between 1st June and 31st August 2006 with ear-related problems were enrolled consecutively into the study. Data analysis was by SPSS version 11. Results: Three thousand and twenty-one children were seen during the study period. Out of these, 248 children (8.2%) presented with ear-related problems. Chronic otitis media (30.5%), acute otitis media (29.9%), cerumen auris (11.3%), otitis externa(10.1%), hearing impairment (7.3%) and foreign body in the ear (5.7%) were the most commonly diagnosed ear-related problems. Conclusion: Ear-related problems among children presenting at the UNTH Enugu were not uncommon. However, otitis media was the most commonly diagnosed ailment affecting the ears in children.

Estudo de um método de avaliação de desempenho aplicado aos técnicos de radiologia do Hospital Curry Cabral

A avaliação do desempenho e a sua aplicação são, no actual enquadramento socioeconómico, cada vez mais necessárias, como forma de melhorar a eficácia e a eficiência entre as organizações. Para a prática profissional verifica-se que a implementação da avaliação de desempenho, apresenta lacunas que podem comprometê-la. Sabendo da importância do profissional para o sucesso da implementação da avaliação de desempenho, toma-se fundamental, analisar a sua percepção face ao modelo e sua implementação. O problema da instrução do presente estudo pretende saber quais as percepções dos técnicos de radiologia avaliados sujeitos ao modelo de avaliação de desempenho implantado no Hospital Curry Cabral. Tendo como objectivo ao nível da gestão, minimizar os obstáculos de implementação e maximizar os pontos fortes. Após pesquisa bibliográfica sobre os principais conceitos, foi definido domo objectivo da investigação empírica: - Comparar as percepções dos técnicos de radiologia submetidos ao modelo de avaliação desempenho ”Pró-Activo”. Recorrendo a uma metodologia exploratória e descritiva, estudámos o impacto dessas ferramentas utilizadas dentro da Unidade Hospitalar do estudo. A metodologia de recolha de informação aos profissionais expostos do estudo assentou em questionários de perguntas fechadas e abertas ambas com uma abordagem de carácter quantitativo. Para a análise e tratamento dos dados utilizou-se programas informáticos. As principais conclusões: verifica-se a falta de formação para todos os envolvidos, um processo desprovido de imparcialidade, neutralidade e rigor, bem como uma motivação geral dos profissionais em matéria de avaliação de desempenho. ABSTRACT - The evaluation of performance and its implementation are, in the current socioeconomic framing, each time more necessary as form to improve the effectiveness and the efficiency amidst the organizations. For the practical professional it is verified that the implementation of the performance evaluation, presents gaps that can compromise it. Knowing the importance of the individuals in the success of the implementation of the performance evaluation, it becomes basic to analyze its perceptions face to the model and its implementation. The problem of inquiry of this study pretends to know which the perceptions of the technicians of radiology evaluated and appraisers face to the models of evaluation of performance implanted in the Portuguese Hospitals (Hospital Curry Cabral). The purpose to the level of the management is to minimize the obstacles of implementation and to maximize the strong points. Bibliographical research on the main concepts was effectuated, after what we define the objectives of empirica inquiry: - To compare the perceptions of the radiology technicians subjected to models of performance evaluation “Pro-Activa”. Using an exploratory and descriptive approach, studied the impact of these tools used in the hospitals of the study. The methodology for collecting information to professionals out of the study based on questionnaires of both open and closed questions with a quantitative approach to nature. For analysis and data processing software was used. The main conclusions: there is the lack of training for all involved, a process devoid of impartiality, neutrality and accuracy, as well as a general motivation of the professionals regarding the evaluation of performance.

Factors associated with gastro-duodenal disease in patients undergoing upper GI endoscopy at the Korle-Bu Teaching Hospital, Accra, Ghana.

Background: There is a high prevalence of gastro-duodenal disease in sub-Saharan Africa. Peptic ulcer disease in dyspeptic patients, 24.5%, was comparable to prevalence of gastro-duodenal disease among symptomatic individuals in developed countries (12 – 25%). Limited data exists regarding its associated risk factors despite accumulating evidence indicating that gastroduodenal disease is common in Ghana. Objectives: This study investigates risk factors associated with gastro-duodenal disease at the Korle-Bu Teaching Hospital, Accra, Ghana. Methods: This study utilized a cross-sectional design to consecutively recruit patients referred with upper gastro-intestinal symptoms for endoscopy. The study questionnaire was administered to study participants. Helicobacter pylori infection was confirmed by rapid-urease examination at endoscopy. Results: Of 242 patients sampled; 64 had duodenal ulcer, 66 gastric ulcer, 27gastric cancer and 64 non-ulcer dyspepsia. Nineteen (19) had duodenal and gastric ulcer while 2 had gastric ulcer and cancer. A third (32.6%) of patients had history of NSAIDuse. H. pylori was associated with gastric ulcer (p=0.033) and duodenal ulcer (p=0.001). There was an increased prevalence of duodenal ulcer in H. pylori-infected patients taking NSAIDs, P=0.003. Conclusion: H. pylori was a major risk factor for peptic ulcer disease. However, NSAID-related gastro-duodenal injury has been shown to be common in H. pylori infected patients. It highlights the need for awareness of the adverse gastro-intestinal effects in a H. pylori endemic area.

Sero-prevalence and associated factors of Helicobacter pylori infection among adult patients with dyspepsia attending the gastroenterology unit in a tertiary hospital in Mwanza, Tanzania.

Background: Prevalence of H. pylori infection varies greatly between populations in different countries. This study was conducted to determine the magnitude of H.pylori among adult patients with dyspepsia attending the gastroenterology unit at Bugando medical centre. Methods: A cross sectional study involving 202 dyspeptic patients was conducted between June and July 2014. A Standardized data collection tool was used to collect socio-demographic characteristics. H.pylori antibodies were detected using rapid immunochromatographic tests according to manufacturer’s instructions. Results: The median age of study population was 42 (IQR: 33-54). Females 105 (51.9%) formed majority of the population studied. Of 202 participants; 119 (58.9%) were from rural areas. Seroprevalence of H.pylori infection was found to be 79/202 (39.1%, 95% CI: 32.3 -45.7). As the age increased the risk of having H.pylori infection also increased (OR: 1.02 95% CI: 1-1.04, P=0.02). On multivariate logistic regression analysis untreated drinking water was found to predict H.pylori seropositivity (OR: 2.33, CI: 1.09-4.96, p=0.028). Conclusion: The seroprevalence of H.pylori among dyspeptic patients is high in this setting. Therefore the community in Mwanza should be educated on the use of safe drinking water in order to minimize H. pylori infections.

A qualidade dos cuidados de enfermagem e a Norma ISO 9001 : Aplicação empírica no Hospital CUF Infante Santo

A preocupação com a qualidade e normalização dos serviços de saúde é cada vez maior, verificando-se que, para responder às progressivas exigências dos utentes, aparecem entidades que criam normas universais, as quais pretendem a garantia da qualidade nos serviços de saúde. Contudo, a implementação de um sistema de gestão da qualidade, através da norma ISO 9001, nestas organizações, é um desafio pela dificuldade de avaliação da qualidade dos serviços prestados- cuidados de saúde. Estando presente num hospital profissional como médicos, enfermeiros e gestores, com características culturais que influenciam a forma de encarar a qualidade e a sua monitorização para a existência de uma mudança profunda, quando se implementa uma política de qualidade, é fundamental conhecer a definição da qualidade de cada profissional, membro de uma cultura e, deste modo, a sua postura perante o fenómeno. O presente trabalho tem como objectivos identificar a percepção dos enfermeiros do Hospital Cuf Infante-Santo, relativamente ao sistema de gestão da qualidade, segundo a norma ISO, e, consequentemente, investigar pontos fortes, pontos fracos, ameaças e oportunidades da implementação dessa norma nessa organização hospitalar. Para atingir os objectivos, foi desenvolvido um modelo de análise, onde se considera o relacionamento entre as características da qualidade em saúde, cultura organizacional hospitalar e do sistema da norma ISO, para o desenvolvimento da melhoria contínua na organização. Os dados, para a elaboração desta dissertação, foram recolhidos através de inquérito por questionários aos enfermeiros do Hospital Cuf Infante-Santo, que se encontravam a laborar na organização aquando da implementação da norma ISO, sendo utilizado o método quantitativo e técnicas do estudo qualitativo na análise de dados orientados para o significado das acções. Do trabalho desenvolvido, conclui-se que a percepção relativamente às alterações na qualidade dos cuidados está limitada pelo facto de a maioria dos respondentes não conhecer o sistema de qualidade (Norma ISO 9001), sendo este um dos pontos fracos para a implementação da norma ISO na organização. Deste modo, a situação diagnosticada constitui um alerta para as organizações de saúde, ao implementarem sistemas de gestão da qualidade, potencializarem os pontos fortes identificados, como a orientação dos enfermeiros para o cuidar e para o cliente e, por outro lado, evitar repetir pontos fracos, como o identificado anteriormente, através do envolvimento e formação dos seus colaboradores nas políticas da qualidade. Os enfermeiros preocupam-se com a qualidade, mas referem que não a monitorizam regularmente. Pelo que, esta necessidade com a implementação do sistema de gestão da qualidade, deverá ser corrigida, de modo a que a organização de saúde em estudo caminhe para a excelência. ABSTRACT: The concern with the quality and standardization of health services is increasing, verifying that to respond to the progressiva demands of the users, there appear entities wishing to create universal standards to ensure the quality in health services. However, implementing a quality management service, through ISO 9001 standard, in these organizations, it is a challenge by the difficulties of evaluation in the quality of the provided services - health care. Being present in a hospital professionals such as doctors, nurses and managers, with cultural characteristics that influence the way and method of facing the quality and its monitoring for the existence of a profound change, when a quality policy is implemented, it is fundamental to know the definition of the quality of each and ever professional, member of a culture, and in this way, their posture towards the phenomenon. This present study aims to identify the perceptions of nurses at the Infante-Santo CUF Hospital, relatively to the quality management system, according to the ISO standard, and consequently, investigating strengths, weaknesses, threats and opportunities of the implementation of this standard in that hospital organization. To achieve these aims or objectives, an analysis model was developed, which considers the relationship between the characteristics of the quality of health, hospital organizational culture and the ISO standard system, for the further development of the continuous improvement in the organization. The data for the elaboration of this dissertation was collected through questionnaire surveys done to the nurses at Infante-Santo CUF Hospital, who were working in the organization during the ISO standard implementation, being used the quantity method and techniques of the quality study in the analysis of data orientated to the meaning of actions. The developed research concluded that the perception related to the alterations in the quality of the care is limited by the majority of respondents not knowing the quality system (ISO 9001 standard), being this one of the weaknesses to the implementation of the ISO standard in the organization. Therefore, the diagnosed situation constituted a warning to the health organizations, to implement quality management systems, potentially the identified strengths, such as the orientation of the nurses to the care and to the client, and on the other hand, avoiding the repetition of weaknesses, as previously identified, through the involvement and training of its employees in the quality policies. The nurses are concerned about the quality but they refer that there is no regular monitoring. Thus, this necessity of the implementation of the quality and management system should be corrected, so that the health organization being studied should proceed to excellence.

Qualidade e triagem de Manchester : Estudo de caso Hospital CUF Descobertas

A saúde em Portugal encontra-se no caminho da mudança, rumo à excelência, pois questiona-se o sistema, a sua estrutura, os seus processos e os resultados. Uma das condições que mais influencia a competitividade entre instituições da saúde é a qualidade. Sendo a sociedade cada vez mais exigente, medi-la e avalia-la é um imperativo da época actual. O presente estudo teve como objectivo, contribuir para a realização de um diagnóstico de um processo de melhoria implementado num hospital privado de Lisboa - Hospital CUF Descobertas (HCD), no Serviço de Atendimento Permanente (SAP), à luz dos princípios da qualidade total. O procedimento da Triagem de Manchester é um processo que tem como principal objectivo o estabelecimento de prioridades, ou seja, identificar critérios de gravidade, de forma objectiva e sistematizada, que indicam a prioridade clínica com que o cliente deve ser atendido e o respectivo tempo de espera alvo recomendado até observação médica. Não se trata de estabelecer diagnósticos. Para o efeito, utilizou-se uma abordagem metodológica, suportada pelo modelo de auto-avaliação, designado Modelo Common Assessment Framework (CAF). Neste sentido, privilegiando-se a utilização dos critérios de meios deste modelo. Foi aplicado um questionário aos colaboradores do Serviço de Atendimento Permanente do Hospital CUF Descobertas. O Tratamento de dados estatísticos foi realizado com o apoio do SPSS, versão 16.0 e do Microsoft Excel. Os resultados deste estudo culminam com a identificação de pontos fortes, pontos fracos e sugestões de melhorias para o serviço em estudo. Neste sentido, este trabalho serviu de diagnóstico para se poder identificar em que ponto se situa e que rumo se deve seguir para se atingir um patamar de excelência relativamente à qualidade. Abstract: Health in Portugal finds itself on the path toward change, trying to find excellence while challenging the system and its structure, processes, and results. One of the conditions that most influences the competitiveness between the institutes of health is quality because society is becoming more demanding. Measuring and evaluating this change is happening in this current time. The present study has the objective of contributing and establishing a diagnostic tool relative to the process of improvement. This tool was used in a private hospital in Lisbon, Hospital CUF Descobertas, in the Emergency Room, in looking at the principles of total quality. This process designed through the Manchester Triage System has the main objective of the establishment of priorities through which we want to identify criteria of seriousness in an objective and systematic way that indicate a clinical priority with which the client is attended to in respect to the waiting time, giving a recommended time until medical observation. ln this sense, we do not diagnose patients in triage. For this effect, we used a methodological overview supported by the model of self-evaluation, the Common Assessment Framework (CAF}, in which we used the criteria: Leadership, Planning and Strategy, People, Resources and Processes. To arrive at this, a questionnaire was used by the collaborators of the emergency room of Hospital CUF Descobertas. The statistical analysis of the data was performed using SPSS version 16.0 and Microsoft Excel. The results of this study culminated with the identification of strong points, weak points, and suggestions for improvements for the work in study. ln this way, with this study, we can identify in where an organization finds itself and the path it should take in order to achieve a high level of quality excellence.

Ten years of hospital admissions for liver cirrhosis in Portugal

Background and aims More data on epidemiology of liver diseases in Europe are needed. We aimed to characterize hospital admissions for liver cirrhosis in Portugal during the past decade. Patients and methods We analyzed all hospital admissions for cirrhosis in Portugal Mainland between 2003 and 2012 registered in the national Diagnosis-Related Group database. Cirrhosis was classified according to etiology considering alcohol, hepatitis B, and hepatitis C. Results Between 2003 and 2012, there were 63 910 admissions for cirrhosis in Portugal Mainland; 74.4% involved male patients. Etiologies of admitted cirrhosis were as follows: 76.0% alcoholic, 1.1% hepatitis B, 1.4% hepatitis B plus alcohol, 3.6% hepatitis C, and 4.0% hepatitis C plus alcohol. There was a significant decline (P <0.001) in admissions for alcoholic cirrhosis, whereas hospitalizations for cirrhosis caused by hepatitis C or hepatitis C plus alcohol increased by almost 50% (P <0.001). Patients admitted with alcoholic plus hepatitis B or C cirrhosis were significantly younger than those with either alcoholic or viral cirrhosis (53.1 vs. 59.4 years, respectively, P <0.001). Hospitalization rates for cirrhosis were 124.4/100 000 in men and 32.6/100 000 in women. Hepatocellular carcinoma and fluid retention were more common in viral cirrhosis, whereas encephalopathy and variceal bleeding were more frequent in alcoholic cirrhosis. Hepatorenal syndrome was the strongest predictor of mortality among cirrhosis complications (odds ratio 12.97; 95% confidence interval 11.95–14.09). In-hospital mortality was 15.2%. Conclusion Despite the decline in admissions for alcoholic cirrhosis and the increase in those related to hepatitis C, the observed burden of hospitalized liver cirrhosis in Portugal was essentially attributable to alcoholic liver disease.

Avaliação de Indicadores de Qualidade no Hospital das Forças Armadas

O presente trabalho de investigação individual (TII) teve como objetivo produzir um índice de avaliação da satisfação dos utentes, delimitado às consultas externas do Hospital das Forças Armadas - Polo de Lisboa (HFAR/PL), a fim de identificar os aspetos positivos e negativos, bem como a qualidade dos serviços prestados, visando melhorar o desempenho desta unidade hospitalar. Para o desenvolvimento do TII seguiu-se um raciocínio hipotético-dedutivo, adotando no domínio metodológico uma estratégia quantitativa e usando como instrumento de recolha de dados, a técnica por inquérito de questionário, num modelo de perguntas fechadas, utilizando para isso a plataforma Survio1. “Como é que os utentes avaliam os serviços prestados nas Consultas Externas do HFAR/PL?”, é a pergunta pela qual foi orientado o presente trabalho, tendo sido avaliadas diversas dimensões (e respetivos indicadores), onde se conclui que a maioria de utentes estão satisfeitos relativamente ao desempenho dos profissionais de saúde (médicos e enfermeiros), embora seja importante refletir sobre outros aspetos, de modo a serem otimizados, visando a melhoria da qualidade do serviço prestado e a satisfação dos utentes. Abstract: This paper’s aim is to produce and analyze an evaluation index of the user’s satisfaction, limited to the scope of Armed Forces Hospital - Lisbon Campus (HFAR /PL) outpatients. This will make it possible to identify positive and negative aspects and evaluate the quality of the services, thus finding ways to improve the performance of the hospital. For the development of the research, a hypothetical-deductive reasoning, adopting a methodological quantitative approach, was used. A closed question survey, based on the Survio Platform, was used as the data collection instrument. The leading question was “How do users evaluate the services provided to Outpatients Consultations by HFAR / PL?". Several dimensions (and their respective indicators) were evaluated, leading to the conclusion that most outpatients are satisfied with the performance of the health professionals (doctors and nurses). Nevertheless, other aspects have been identified as needing optimization in order to improve the quality of the service and the user’s satisfaction.

Conocimientos de las enfermeras en la seguridad farmacoterapéutica de los antibióticos en las Areas de Clínica, Cirugía, y Emergencia del Hospital Homero Catanier Crespo. Azogues, 2015

ANTECEDENTES: La práctica de las profesionales de enfermería en el manejo de medicamentos, se considera un reto, puesto que deben tener conocimientos y aplicar técnicas relacionadas con la seguridad farmacoterapéutica necesarios para la prevención de efectos adversos que prolongan los días de estadía del paciente, en el área hospitalaria. OBJETIVO GENERAL: Determinar los conocimientos de las enfermeras en la seguridad farmacoterapéutica de los antibióticos en las áreas de clínica, cirugía y emergencia del hospital Homero Castanier Crespo. METODOLOGÍA Y TÉCNICA: Se trata de un estudio cuantitativo, descriptivo que valora la aplicación de los conocimientos que tienen las enfermeras en la seguridad farmacoterapéutica de los antibióticos. El universo lo conformaron 25 profesionales de enfermería que laboran en los turnos de la mañana, tarde y noche en las áreas de clínica, cirugía y emergencia, no se realizó cálculo muestral por considerar que el universo es pequeño. La técnica de investigación aplicada fue la observación y el instrumento es un formulario de encuesta para la recolección de datos, el procesamiento de la información se realizó en el programa Excel y SPSS, los resultados son representados en tablas con frecuencias y porcentajes. RESULTADOS: En las áreas de clínica, cirugía y emergencia del Hospital Homero Castanier Crespo reportan que un 66.7% de enfermeras tienen un nivel medio de conocimientos y el 33.3% no dispone de conocimientos, evidenciándose una rutinización en la práctica de administración de medicamentos. CONCLUSIONES._ Los resultados de la investigación muestran que en la administración de antibióticos predomina la rutina en el personal