A medição de eventos adversos hospitalares através dos dados administrativos

RESUMO - A qualidade e segurança são pilares essenciais dos sistemas de saúde modernos. A sua monitorização e avaliação tem como primeiro passo o conhecimento da realidade no que se refere aos eventos adversos que afetam os utentes. Existem diversas metodologias de medição de eventos adversos. A revisão de processos clínicos, apesar de constituir o padrão de ouro, não permite, ao contrário da análise dos dados administrativos, avaliar de forma abrangente, os episódios de internamento. Esta metodologia a partir de dados recolhidos rotineiramente em inúmeros países, como Portugal, apresenta porém diversas limitações, para as quais têm sido instituídas soluções tais como a sinalização do momento de aquisição do diagnóstico, que pela recente instituição não foi utilizada neste trabalho. Num hospital do Sistema nacional de saúde em Portugal, pela análise dos dados administrativos, determinou-se nos episódios de internamento cirúrgico uma incidência de 2,5% de eventos adversos. Comprovou-se a relação de idade, sexo masculino e admissão urgente com a sua ocorrência. Os doentes que sofreram um evento adverso apresentaram uma probabilidade de óbito bastante superior (odds ratio 12,2) e apresentaram tempos de internamento médio prolongados em cerca de vinte dias. Estes dados não são contudo ajustados para o risco do doente e das intervenções a que são sujeitos. Se forem considerados os tempos de internamento das tabelas de GDH em Portugal, o prolongamento do internamento é de 8,4 dias. A avaliação dos custos adicionais, realizada pelos dias de internamento adicionais, está condicionada à questão metodológica atrás reportada, estimando-se implicações de 1,1% a 8,8% de dias de internamento, com custos de 1.000.000 a 8.600.000 Euros. Em Portugal a monitorização sistemática da ocorrência de eventos, e consequentemente das implicações para a saúde do doente e custos financeiros, não é ainda uma realidade. A implementação do código "presente na admissão" permitirá dar o passo seguinte na utilização dos dados administrativos na compreensão do fenómeno dos eventos adversos.

Efeito fim-de-semana e noite : impacto do momento de admissão sobre a mortalidade e a demora média no internamento

RESUMO - Contexto: Admite-se a existência de variações no número e nível de experiência dos profissionais de saúde disponíveis nos hospitais durante a noite e o fim-de-semana. As consequências desta situação na qualidade dos cuidados de saúde prestados expõem a importância deste estudo realizado com o objetivo de avaliar o impacto do momento de admissão sobre a mortalidade e a demora média no internamento. Metodologia: Foram estudados 201 369 episódios urgentes, admitidos com um de 36 diagnósticos principais, de acordo com as informações na base de dados dos resumos de alta, para o ano de 2012. O momento de admissão foi definido por período (dias úteis/fim-de-semana) e por hora (dia/noite), e estimaram-se os efeitos fim-de-semana e noite ao nível da mortalidade e da demora média em modelos de regressão logística. Resultados: Registou-se um aumento de 3% no risco de morte, em doentes admitidos ao fim-de-semana. Diferenças que não se verificaram entre os doentes admitidos de dia e de noite. Relativamente à demora média, verificou-se um aumento de 3% na probabilidade dos doentes admitidos durante o fim-de-semana terem uma demora média de internamento superior. Assim como os doentes admitidos durante a noite apresentaram um aumento de 2,9% na probabilidade de terem demora média de internamento mais longa. Conclusão: Os dados apresentados permitem um melhor conhecimento sobre a influência da variação da atividade hospitalar ao longo do dia e da semana nos hospitais portugueses, identificando a necessidade de aprofundar o tema e de implementar medidas que suprimam os efeitos fim-de-semana e noite.

Da valoração de gravações e fotografias obtidas por particulares no processo penal

Recordings and photographs obtained by private individuals can be two of the most relevant evidences in helping finding the truth; however, they can also conflict with fundamental rights such as privacy, spoken word or image of the targets. It is not enough that only the violation of the right to privacy is withdrawn because rights to spoken word or image, unattached from the first one, show up independently as the main violated rights and are criminally protected in article 199º of the criminal code. Its use as evidence is, on a first moment, dependent on the private's conduct lawfulness, as it is stated in article 167º of the criminal procedure code. In order to consider its lawfulness, and accept its use as evidence, portuguese higher courts have been defending constructions mostly based on legal causes of defense. Although agreeing with a more flexible position of weighing all the interests at stake instead of denying its use as evidence, we believe notwithstanding that some of these solutions are misleading and shall not be spared from critics. Lastly, even if we reach a positive conclusion about the lawfulness of obtaining and using recordings and photogtaphs carried out to court by private individuals, they must not be however automatically admitted as evidence, still being necessary to proceed to a separate weighting, within the criminal procedure and its own legal rules, about their real purposes in the case.

A responsabilidade da sociedade diretora com os credores da sociedade subordinada

The scope of the present study encompasses the liability of the directing company for the obligations of the subordinated company. Whereas the concept of directing company is comprised in the broader context of groups of companies and, consequently, in the comprehensive framework of the relationships established among such entities, this study starts by defining the notion of groups of companies, distinguishing it from related figures. It, then, moves on to analyse the legal regime applicable to groups of companies in some legal systems deemed significant, notably the American, European and German systems. Finally, this paper scrutinizes the provisions of article 501 of the Portuguese Companies Code (“Códigodas Sociedades Comerciais”), in particular its systematics and peculiarities, so as to ascertain which is the liability scheme 2 applicable to the directing or dominant company for the obligations of the subordinates or dominated company. Pursuant to no. 1 of article 501of the CSC, the directing company’s liability for such obligations exists provided these commitments are born before, during and until such time the subordination contract is terminated. The liability of the directing or dominant company for the debts of the subordinated or dominated company ceases as of the moment when the relationship between those two entities no longer exists, with immediate effect.

As 'conversas informais' extraprocessuais como meio de prova em processo penal

In the present thesis, we examine the approach to the so-called “informal conversations”, especially between a suspect or defendant and criminal police authorities. Our goal is to understand if criminal police authorities are allowed to testify about the content of these conversations, revealing facts that the suspect or defendant may have shared with them, as well as about evidence that they may have acquired through these statements. Firstly, we briefly present the notion of “informal conversations” and the great variety of situations they may encompass: intra or extra-procedural; prior or subsequent to someone acquires the status of defendant. Secondly, we analyse some of the principles and rules that are involved in this controversial issue: principles concerning the procedural structure, organization and dynamic; principles concerning the production and assessment of evidence in the trial hearing; principles concerning the prosecution and the powers of criminal police authorities; the procedural status of the defendant; the rules concerning the reading of statements in the trial hearing; the rules concerning hearsay testimonies. Thirdly, we go through the great amount of case law on the so-called “informal conversations” and related matters, analysing the most relevant cases and the arguments that sustain them, as well as the legal literature. Our goal is to understand the evolution, throughout the last two decades, of the different opinions regarding the approach to the various situations in which “informal conversations” may occur and in which the admissibility of a testimony by criminal police authorities is questioned. Finally, we defend a different approach for testimonies by criminal police authorities prior and subsequent to someone acquiring the status of defendant. We see the moment when someone acquires the status of defendant as a border area in the admissibility of “informal conversations”, because from then on the statements have to be collected and assessed according to the law, so all the other conversations (or any other evidence) collected informally are irrelevant. As to the specific case of the testimony about the re-enactment of the crime, given the high degree of difficulty in separating the defendant’s contributions that may be considered essential and those that may be considered less useful, but still relevant, we support the qualification of the defendant’s contributions as inseparable from the re-enactment, allowing it to be replicated and assessed in the trial hearing with no restrictions.

Home Banking

The object of this dissertation is focused on the study of the home banking service and how the allocation of losses due to computer fraud is processed in the scope of this service. When considering the questions raised by the allocation of losses associated with fraudulent operations, it is important to consider, mainly, the behaviour of the user of the home banking service. In our opinion, courts have been too demanding towards the user when judging his action in the use of this service. In this study, we have concluded that, when the user “falls” into a computer fraud scheme, he should not be liable for gross negligent behaviour, even if, due to the fraud, the user revealed all his access codes to a hacker on a page similar to that of his bank. In general, such facts will not be sufficient to qualify the user’s action as grossly negligent. Therefore, the user, under the terms of the Payment Services’ System, must bear the loss up to a maximum of €150, and the bank will face the remainder of the losses. However, if the user, victim of a fraudulent technique, ignored the safety warnings issued by the bank, one must consider, given the specific case, that he contributed to gross negligence in unauthorised payment transactions. Thus, the user must bear all the losses up to the moment when he notifies the bank about the unauthorised transactions. It is the bank’s responsibility to, given the specific case, adduce evidence of the client’s contribution to the identified losses.

Stops and bonanzas in the EU: Does being part of the Euro Area make a difference?

In this paper, we investigate whether being part of the euro area influences the conditional probability of going through a sudden stop or a bonanza of capital flows. Our sample period is from 1995 until 2014. We identify these two phenomena and we evaluate which push and pull factors help predict the conditional probability of experiencing one of them. We find that most countries had significant capital inflows until 2008 and that there were more sudden stops during the recent financial crisis than in any other moment in our sample. The factors that better help forecast the conditional probability of a sudden stop are global uncertainty (represented by the push factor “Volatility Index”), and the domestic economic activity (pull factors “GDP growth” and “consumer confidence”). An indicator of country risk (pull factor “change in credit rating”) is the most significant one for predicting bonanzas. Ultimately, we find no evidence that being part of the euro area influences the conditional probability of going through a sudden stop or a bonanza.

Human immunodeficiency virus/Leishmania infantum in the first foci of urban American visceral leishmaniasis: clinical presentation from 1994 to 2010

INTRODUCTION:Human immunodeficiency virus (HIV) coinfection with Leishmania infantum or Leishmania donovani, the agents of visceral leishmaniasis (or kala-azar), has become a fatal public health problem in the tropics where kala-azar is endemic.METHODS:The clinical presentation of patients with HIV and L. infantum coinfection is described using two unique databases that together produce the largest case series of patients with kala-azar infected with HIV in South America. First, a retrospective study paired the list of all patients with kala-azar from 1994 to 2004 with another of all patients with HIV/AIDS from the reference hospital for both diseases in the City of Teresina, State of Piauí, Brazil. Beginning in 2005 through to 2010 this information was prospectively collected at the moment of hospitalization.RESULTS:During the study, 256 admissions related to 224 patients with HIV/L. infantum coinfection were registered and most of them were males between 20-40 years of age. Most of the 224 patients were males between 20-40 years of age. HIV contraction was principally sexual. The most common symptoms and signs were pallor, fever, asthenia and hepatosplenomegaly. 16.8% of the cohort died. The primary risk factors associated to death were kidney or respiratory failure, somnolence, hemorrhagic manifestations and a syndrome of systemic inflammation. The diagnosis of HIV and kala-azar was made simultaneously in 124 patients.CONCLUSIONS:The urban association between HIV and kala-azar coinfection in South America is worrisome due to difficulty in establishing the diagnosis and higher mortality among the coinfected then those with either disease independently. HIV/L. infantum coinfection exhibits some singular characteristics and due to its higher mortality it requires immediate assistance to patients and greater research on appropriate combination therapy.

Experimental characterization of an earth eco-efficient plastering mortar

Earthen plastering mortars are becoming recognized as highly eco-efficient. The assessment of their technical properties needs to be standardized but only the German standard DIN 18947 exists for the moment. An extended experimental campaign was developed in order to assess multiple properties of a ready-mixed earth plastering mortar and also to increase scientific knowledge of the influence of test procedures on those properties. The experimental campaign showed that some aspects related to the equipment, type of samples and sample preparation can be very important, while others seemed to have less influence on the results and the classification of mortars. It also showed that some complementary tests can easily be performed and considered together with the standardized ones, while others may need to be improved. The plaster satisfied the requirements of the existing German standard but, most importantly, it seemed adequate for application as rehabilitation plaster on historic and modern masonry buildings. Apart from their aesthetic aspect, the contribution of earthen plasters to eco-efficiency and particularly to hygrometric indoor comfort should be highlighted.

Corporate social responsibility

There is general consensus nowadays that CSR is not just altruistic do-gooding but rather a way for both companies and society to prosper. Companies themselves increasingly recognize that their sustainability depends on their willingness to assume responsibility for social and environmental issues. Academic research has, in the past, tried to theorize exactly how CSR improves business, employee satisfaction and productivity. However, few studies have a) separated the different effects of internal CSR and external CSR and b) studied these effects in times of internal organizational distrust. Hence, this paper examines the relationship between each type of CSR with two outcome variables related to employee attitudes: affective organizational commitment (AOC) and turnover intentions (TI). Furthermore, it investigates whether organizational distrust works as a moderator in each of these relationships by testing the hypothesis using a sample of 212 employees from a company that is currently going through a moment of internal crisis. Findings suggest that although all variables are strongly correlated, distrust works as a moderator for external CSR but not for internal CSR. The theoretical and practical implications of these findings conclude the paper.

Management consulting Winning

A few decades ago, global management consulting was considered to be one of the most attractive industries due to its abnormal high profit margins and above-average growth rates. However, after the dot-com bubble in 2000 and the last global financial crisis, firms folded and growth rates declined sharply. In an attempt to overcome the uncertainty and information volatility, internationalization is commonly cited as a good strategy. WMC, a Portuguese SME founded in 2012, has now decided to expand its management consulting services. Therefore, a scoring model was created to assess selected European countries’ attractiveness taking into consideration macro and microeconomic data. Results show that Spain is the best option at the moment, mainly because it is where the company has the larger number of projects already developed and is more likely to leverage its network.

Dor e parentalidade : A vinculação na criança hospitalizada

Dissertação de Mestrado apresentada ao ISPA - Instituto Universitário

Fabrication and characterization of transparent conductive oxide surface sensors for electrocorticography – TrECoG

Understanding how the brain works has been one of the greatest goals of mankind. This desire fuels the scientific community to pursue novel techniques able to acquire the complex information produced by the brain at any given moment. The Electrocorticography (ECoG) is one of those techniques. By placing conductive electrodes over the dura, or directly over the cortex, and measuring the electric potential variation, one can acquire information regarding the activation of those areas. In this work, transparent ECoGs, (TrECoGs) are fabricated through thin film deposition of the Transparent Conductive Oxides (TCOs) Indium-Zinc-Oxide (IZO) and Gallium-Zinc-Oxide (GZO). Five distinct devices have been fabricated via shadow masking and photolithography. The data acquired and presented in this work validates the TrECoGs fabricated as efficient devices for recording brain activity. The best results were obtained for the GZO- based TrECoG, which presented an average impedance of 36 kΩ at 1 kHz for 500 μm diameter electrodes, a transmittance close to 90% for the visible spectrum and a clear capability to detect brain signal variations. The IZO based devices also presented high transmittance levels (90%), but with higher impedances, which ranged from 40 kΩ to 100 kΩ.

Analysis of a controversial decision process: the case of the pumped hydro storage power plant Atdorf in Germany

Based on the report for the unit “Métodos Interactivos de Participação e Decisão A” (Interactive methods of participation and decision A), coordinated by Prof. Lia Maldonado Teles de Vasconcelos and Prof. Nuno Miguel Ribeiro Videira Costa. This unit was provided for the PhD Program in Technology Assessment in 2015/2016.

MarketOpolis: A market simulation based on investors decisions

This study aims to replicate Apple’s stock market movement by modeling major investment profiles and investors. The present model recreates a live exchange to forecast any predictability in stock price variation, knowing how investors act when it concerns investment decisions. This methodology is particularly relevant if, just by observing historical prices and knowing the tendencies in other players’ behavior, risk-adjusted profits can be made. Empirical research made in the academia shows that abnormal returns are hardly consistent without a clear idea of who is in the market in a given moment and the correspondent market shares. Therefore, even when knowing investors’ individual investment profiles, it is not clear how they affect aggregate markets.