Paradigma da formação em contexto hospitalar: Análise da realidade percepcionada pelos enfermeiros de cuidados gerais

A presente investigação empírica, desenvolvida na área da formação contínua, procura compreender como se processa a formação continua em contexto de trabalho dos enfermeiros de uma organização hospitalar, centrando-se na percepção e representações dos enfermeiros de cuidados gerais sobre a qualidade, autopercepção do impacte e importância da formação no desenvolvimento de competências e motivação para a participação na formação contínua, como forma de promover o desenvolvimento de competências. Considerando-se que a problemática do paradigma da formação, subsiste na falta de articulação entre os processos comunicacionais, motivadores, procedimentais e dos recursos à disposição dos usuários e gestores da formação, a nível micro dos serviços da organização e macro da tutela o que contribui para a inexistência de resultados quantificáveis, em termos de eficácia e eficiência da formação no desenvolvimento de competências dos colaboradores e crescimento da organização. Apesar da formação contínua, nas organizações, objectivar o desenvolvimento de competências, implicar a construção de um quadro de referência a partir de uma abordagem multidisciplinar, de forma a incluir a complexidade dos fenómenos, a investigação dos factores determinantes que concorrem para a performance dos enfermeiros, parece ser uma abordagem imprescindível para compreender e analisar a problemática na sua dimensão. O estudo empírico consistiu numa investigação exploratória/descritiva, partindo de uma amostragem não probabilística, optando-se por uma metodologia quantitativa, através da aplicação de questionários a 208 enfermeiros da prestação de cuidados, de uma organização hospitalar pública EPE, da Administração Regional de Saúde de Lisboa e Vale do Tejo. Esta investigação permitiu verificar que no geral, os enfermeiros têm uma percepção positiva sobre a qualidade da formação contínua desenvolvida no serviço onde desempenham funções. Maioritariamente consideram importante a formação contínua como factor de desenvolvimento de competências, sentem-se motivados e participam activamente na formação. No entanto, não se conseguiu efectuar qualquer tipo de inferências ou correlações entre as variáveis de estudo constatando-se que os enfermeiros responderam frequentemente e Sempre, na grande maioria das questões, havendo heterogenia nas respostas a questões semelhantes. O estudo demonstrou que apesar da percepção positiva dos enfermeiros sobre a formação contínua desenvolvida no serviço, não se consegue ter a verdadeira percepção de como é conduzida a formação em serviço qual o seu impacte na melhoria do desempenho dos enfermeiros e se a organização evidencia uma cultura de formação voltada para uma estratégia de melhoria continua das qualificações dos enfermeiros. À luz dos resultados, foi desenvolvido um projecto de intervenção sócio-organizacional na área da gestão da formação, numa perspectiva de estratégia de desenvolvimento organizacional, melhoria das competências individuais e proposto um portfólio de descrição de funções do enfermeiro responsável pela formação. ABSTRACT: This study, based on the issues of continuous professional training in the hospital setting, as a factor to develop nurses competencies, intends to understand how the training program in the hospital milieu is conducted, focusing on perceptions and concepts of quality, impact, importance and motivation to participate in ongoing professional training, according to general care registered nurses point of view. The study main goal is to identify how is developed professional training in a medical institution from Sub-Região de Saúde de Lisboa and Vale do Tejo, and evaluate the impact of the training program. Considering that a problematic exists in the articulation between the communication processes, motivational drives, procedures and resources at the disposition of the participants and managers of the professional development program, at a micro level of services in the organization and at a macro level of the government policies and organizational strategies leaders; which contributed to the absence of quantifiable results and little evidence, in terms of efficiency of the professional development program to enhance the professional competencies of those participating in the study. The investigation of the factorial determinants related to nurse’s efficient performance enhanced by participating in continuous professional training, seems to be an imperative approach to understand and analyze the problematic in its own dimension. The empirical study consisted in an exploratory/descriptive investigation, departing from a random sample, by means of a quantitative methodology approach; through the use of questionnaires being administered to 208 nurses in general care, from a public medical organization. This study, allowed to verify that nurses have a positive perception of the professional development programs established in their workplace, and the competencies of those nurses in charge of delivering the program. The majority, considered the maintenance of a continuous professional development program, imperative to maintain good professional skills; they feel motivated and actively participate in professional development programs. However, it was not possible to make any correlations between the variables of the study, noticing that the nurses answered frequently and always, to the majority of the questions. The study demonstrated that even though nurses have a positive perception of professional development in terms of their workplace, it was inconclusive to ascertain the training quality programs delivered at medical facilities. ln conclusion, a plan of intervention centered on a socio-organizational model, was developed to create a uniform, procedural approach to developing high standards competencies for the registered nurses, by a professional training program, that include monitoring the process and assessing the results of the program. Management competencies according to a balanced scorecard it's another proposal of this study.

Avaliação probabilística do risco de giberela do trigo considerando a influencia do ENOS.

A giberela é uma importante doença na cultura do trigo cujas epidemias ocorrem sob a influência marcante de condições ambientais específicas durante o florescimento. Neste trabalho, a influência do fenômeno El Nino/Oscilação Sul (ENOS) sobre o risco de epidemias da giberela do trigo, em Passo Fundo, RS, estimado com modelos de simulação, foi avaliada via abordagem de anos análogos. Foi utilizada uma série local histórica (1957 a 2006) de dados meteorológicos para estimar um índice de risco de giberela (IRG) para diferentes datas de plantio (1 a 30/06) nos 50 anos da série. Para quantificar a influência do ENOS, foram comparadas medianas e funções probabilidade de excedância (FPE) do IRG (Prob(IRG>y)para três fases do ENOS (quente, fria e neutra) nos anos da série, utilizando métodos não paramétricos. Foi observado um efeito pronunciado do ENOS, principalmente para a fase fria, onde o risco estimado de epidemias moderadas ou severas foi nulo para todas as datas de plantio. Nas demais fases, o referido risco variou de 0,10 a 0,25.

Aplicação do escore MELD em pacientes submetidos a transplante de fígado: análise retrospectiva da sobrevida e dos fatores preditivos a curto e longo prazo

BACKGROUND: The model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis. There are few reports studying the correlation between MELD and long-term posttransplantation survival. AIM: To assess the value of pretransplant MELD in the prediction of posttransplant survival. METHODS: The adult patients (age >18 years) who underwent liver transplantation were examined in a retrospective longitudinal cohort of patients, through the prospective data base. We excluded acute liver failure, retransplantation and reduced or split-livers. The liver donors were evaluated according to: age, sex, weight, creatinine, bilirubin, sodium, aspartate aminotransferase, personal antecedents, brain death cause, steatosis, expanded criteria donor number and index donor risk. The recipients' data were: sex, age, weight, chronic hepatic disease, Child-Turcotte-Pugh points, pretransplant and initial MELD score, pretransplant creatinine clearance, sodium, cold and warm ischemia times, hospital length of stay, blood requirements, and alanine aminotransferase (ALT >1,000 UI/L = liver dysfunction). The Kaplan-Meier method with the log-rank test was used for the univariable analyses of posttransplant patient survival. For the multivariable analyses the Cox proportional hazard regression method with the stepwise procedure was used with stratifying sodium and MELD as variables. ROC curve was used to define area under the curve for MELD and Child-Turcotte-Pugh. RESULTS: A total of 232 patients with 10 years follow up were available. The MELD cutoff was 20 and Child-Turcotte-Pugh cutoff was 11.5. For MELD score > 20, the risk factors for death were: red cell requirements, liver dysfunction and donor's sodium. For the patients with hyponatremia the risk factors were: negative delta-MELD score, red cell requirements, liver dysfunction and donor's sodium. The regression univariated analyses came up with the following risk factors for death: score MELD > 25, blood requirements, recipient creatinine clearance pretransplant and age donor >50. After stepwise analyses, only red cell requirement was predictive. Patients with MELD score < 25 had a 68.86%, 50,44% and 41,50% chance for 1, 5 and 10-year survival and > 25 were 39.13%, 29.81% and 22.36% respectively. Patients without hyponatremia were 65.16%, 50.28% and 41,98% and with hyponatremia 44.44%, 34.28% and 28.57% respectively. Patients with IDR > 1.7 showed 53.7%, 27.71% and 13.85% and index donor risk <1.7 was 63.62%, 51.4% and 44.08%, respectively. Age donor > 50 years showed 38.4%, 26.21% and 13.1% and age donor <50 years showed 65.58%, 26.21% and 13.1%. Association with delta-MELD score did not show any significant difference. Expanded criteria donors were associated with primary non-function and severe liver dysfunction. Predictive factors for death were blood requirements, hyponatremia, liver dysfunction and donor's sodium. CONCLUSION: In conclusion MELD over 25, recipient's hyponatremia, blood requirements, donor's sodium were associated with poor survival.

Conseqüências da análise incorreta de experimentos blocados

Errors are always present in experimental measurements so, it is important to identify them and understand how they affect the results of experiments. Statistics suggest that the execution of experiments should follow random order, but unfortunately the complete randomization of experiments is not always viable for practical reasons. One possible simplification is blocked experiments within which the levels of certain factors are maintained fixed while the levels of others are randomized. However this has a cost. Although the experimental part is simplified, the statistical analysis becomes more complex.

O estado da arte da cromatografia associada à espectrometria de massas acoplada à espectrometria de massas na análise de compostos tóxicos em alimentos

Chromatography combined with several different detection systems is one of the more used and better performing analytical tools. Chromatography with tandem mass spectrometric detection gives highly selective and sensitive analyses and permits obtaining structural information about the analites and about their molar masses. Due to these characteristics, this analytical technique is very efficient when used to detect substances at trace levels in complex matrices. In this paper we review instrumental and technical aspects of chromatography-tandem mass spectrometry and the state of the art of the technique as it is applied to analysis of toxic substances in food.

Validação e estimativa da incerteza de método para análise de licopeno e β-caroteno em polpa de tomate por cromatografia líquida de alta eficiência

A method to quantify lycopene and β-carotene in freeze dried tomato pulp by high performance liquid chromatography (HLPC) was validated according to the criteria of selectivity, sensitivity, precision and accuracy, and uncertainty estimation of measurement was determined with data obtained in the validation. The validated method presented is selective in terms of analysis, and it had a good precision and accuracy. Detection limit for lycopene and β-carotene was 4.2 and 0.23 mg 100 g-1, respectively. The estimation of expanded uncertainty (K = 2) for lycopene was 104 ± 21 mg 100 g-1 and for β-carotene was 6.4 ± 1.5 mg 100 g-1.

Experimento didático de quimiometria para análise exploratória de óleos vegetais comestíveis por espectroscopia no infravermelho médio e análise de componentes principais: um tutorial, parte I

This manuscript aims to show the basic concepts and practical application of Principal Component Analysis (PCA) as a tutorial, using Matlab or Octave computing environment for beginners, undergraduate and graduate students. As a practical example it is shown the exploratory analysis of edible vegetable oils by mid infrared spectroscopy.

Análise do investimento em climatização para bovinos de leite em sistema de alojamento free-stall

The difficulty in adapting European dairy cows breeds in Brazil affect considerably the milk production sector. Brazilian climatic conditions are not totally favorable and the development of new tecnologies is needed for the animals express their genetic potential, as well as their best feed conversion. An economical analysis of the applied investment in the free-stall climatization equipment in dairy housing, for estimating studies related to profit, possibility of return investment as well as time for this return is necessary. The objective of this research was to evaluate the influence of climatization investment in the milk production process and analyze the economical aspect of this investment. There were used 470 high productive dairy cows with genetic and morphologic homogeneous characteristics, and analyzed in two similar periods. Investment calculations were done using Excell®. The results were satisfactory and the invested capital was proved to return to the producer in a short term, 57 days.

Modelo de programação quadrática para análise da movimentação logística e comercialização da soja brasileira

The purpose of this work was to analyze the logistical distribution of Brazilian soybean by applying a quadratic programming to a spatial equilibrium model. The soybean transportation system is an important part of the soybean complex in Brazil, since the major part of the costs of this commodity derives from the transportation costs. Therefore, the optimization of this part of the process is essential to a better competitiveness of the Brazilian soybean in the international market. The Brazilian soybean complex have been increasing its agricultural share in the total of the exportation value in the last ten years, but due to other countries' investments the Brazilian exportations cannot be only focused on increasing its production but it still have to be more efficient. This way, a model was reached which can project new frames by switching the transportation costs and conduce the policy makers to new investments in the sector.

Análise de aspectos socioeconômicos e tecnológicos da agropecuária na Bacia Hidrográfica do Rio Mogi Guaçu

Currently, owing to the occurrence of environmental problems, along with the need of environmental preservation, both the territory management of Hydrographic Basin and the conservation of natural resources have proven to have remarkable importance. Thus, the mean goal of the research is to raise and scrutinize social-economic and technologic data from the Mogi Guaçu River Hydrographic Basin (São Paulo, Brazil). The aim is to group municipalities with similar characteristics regarding the collected data, which may direct joint actions in the Hydrographic Basin Management. There were used both the methods of factorial analysis and automatic hierarchical classifications. Additionally, there is going to be applied a Geographical Information System to represent the outcomes of the methods aforementioned, through the evolvement of a geo-referenced database, which will allow the obtainment of information categorically distributed including theme maps of interest. The main characteristics adopted to group the municipalities were: agricultural area, sugar cane production, small farms, animal production, number of agriculture machinery and equipments and agricultural income. The methodology adopted in the Mogi Guaçu River Hydrographic Basin will be analyzed vis-à-vis its appropriateness on basin management, as well as the possibility of assisting the studies on behalf of the São Paulo Hydrographic Basin groups, to regional development.

Análise de custo-efetividade de métodos preventivos para superfície oclusal de acordo com o risco de cárie: resultados de um ensaio clínico controlado

This study presents the results of a cost-effectiveness analysis in a controlled clinical trial on the effectiveness of a modified glass ionomer resin sealant ( Vitremer, 3M ESPE) and the application of fluoride varnish (Duraphat, Colgate) on occlusal surfaces of first permanent molars in children 6-8 years of age (N = 268), according to caries risk (high versus low). Children were examined semiannually by the same calibrated dentist for 24 months after allocation in six groups: high and low risk controls (oral health education every three months); high and low risk with varnish (oral health education every three months + varnish biannually); and high and low risk with sealant (oral health education every three months + a single application of sealant). Economic analysis showed that sealing permanent first molars of high-risk schoolchildren showed a C/E ratio of US$ 119.80 per saved occlusal surface and an incremental C/E ratio of US$ 108.36 per additional saved occlusal surface. The study concluded that sealing permanent first molars of high-risk schoolchildren was the most cost-effective intervention.

Análise da estrutura de duas unidades fitofisionômicas de savana (cerrado) no sul do Brasil

The Jaguariaiva region is located at Parana State, southern Brazil, and it keeps up the last remnants of savanna vegetation in the State. Thus, it should be considered a mark of the meridional distribution limit of this vegetation type in Brazil. The Parque Estadual do Cerrado (24º09' S; 50º18' WG), whose vegetation is not solely composed by savanna forms, was the object of this study that analysed the vegetation of two dominant savanna physiognomic types (cerrado sensu stricto and campo cerrado). Twenty quadrats of 200m² (20 x 10m) were sistematicaly established in each physiognomic unit, and all the individuals having Basal Perimeter (BP) over 15 cm were sampled. The survey results indicated a low number of woody species in both units (33 species in cerrado sensu stricto and 18 in campo cerrrado). Most important species were virtually the same for both units, specially Byrsonima coccolobifolia, Acosinium subelegans, Couepia grandiflora and Stryphnodendron adstringens. The total density, total dominance and diversity were higher in cerrado sensu stricto. Moreover. there was apparently a higher lloristic resemblance with savannas of São Paulo State, specially those located in the South of thc State.

Análise epidemiológica das fraturas acetabulares

This aim of this work was to carry out an epidemiological study on acetabular fractures in the city of Campinas and surrounds, in view of the few published papers on this subject. Medical files with a diagnosis of acetabular fracture between the years 2004 and 2008 that were made available by the Medical Archiving Service of Hospital das Clínicas, State University of Campinas (UNICAMP) were analyzed by six observers. Data on patients' ages, sex, side affected by the fracture, mechanism of injury, material used for synthesis, complications of the operation, associated fractures, length of hospitalization before and after the surgery, time of total internment and number of physiotherapy sessions before and after the surgery were gathered. It was observed in this population that the left side was more affected; the mechanism of injury that most often caused this type of fracture was automobile accidents; injuries to the sciatic nerve were the commonest surgical complications; and the synthesis material most used was reconstruction plates.

Hipotaxe e Gramaticalização: uma Análise das Construções de Tempo e de Condição

This paper studies complex sentences with temporal hypotatic clauses and with conditional hypotatic clauses in order to investigate the degree of grammaticalization shown by these two kinds of utterances. Our hypothesis is that the more the hypotatic clause is integrated to the nuclear clause, the greater is the degree of grammaticalization. Such degree of integration was measured according to three groups of factors, and the results show that, regarding two of the variables evaluated, the conditional clauses are the most integrated to their nucleus, but, in another rank of evaluation, the temporal clauses are the most integrated ones. Considering that this study is based on a functionalist view, the results may be interpreted according to the principle that there is a competition of motivations in the use of language, so that each utterance reflects the balance of such forces.

Análise bayesiana do modelo de herança monogênica no melhoramento vegetal: um exemplo com abobrinha

A common breeding strategy is to carry out basic studies to investigate the hypothesis of a single gene controlling the trait (major gene) with or without polygenes of minor effect. In this study we used Bayesian inference to fit genetic additive-dominance models of inheritance to plant breeding experiments with multiple generations. Normal densities with different means, according to the major gene genotype, were considered in a linear model in which the design matrix of the genetic effects had unknown coefficients (which were estimated in individual basis). An actual data set from an inheritance study of partenocarpy in zucchini (Cucurbita pepo L.) was used for illustration. Model fitting included posterior probabilities for all individual genotypes. Analysis agrees with results in the literature but this approach was far more efficient than previous alternatives assuming that design matrix was known for the generations. Partenocarpy in zucchini is controlled by a major gene with important additive effect and partial dominance.