En översikt av vilka faktorer som har samband med patientens upplevelse av kontinuitet i vården : En litteraturstudie

Forskning visar på att patienter önskar kontinuitet, då de upplever att det bidrar till känslan av trygghet och närhet. Det ger sjuksköterskan möjlighet att lära känna personen och en möjlighet att bättre följa upp gjorda åtgärder. Syfte Syftet med denna studie var att beskriva vilka faktorer som har samband med patientens upplevelse av kontinuitet i vården. Metod Studien har genomförts som en litteraturstudie. Resultat Resultatet visade att det var viktigt för kontinuiteten att de fick träffa en sjuksköterska som de kände sedan tidigare och att det var samma sjuksköterska vid alla vårdtillfällen. Det var även viktigt att sjuksköterskan de träffade var uppdaterad på deras medicinska historia. En viktig faktor som höjde kontinuiteten var om patienten hade en kronisk sjukdom, då de patienterna oftare kräver regelbunden uppföljning med fler besök hos vården. Patienterna upplevde större kontinuitet om vården utfördes av sjuksköterska istället för av andra vårdgivare Sjuksköterskorna var mer anpassningsbara, flexibla och tog sig mer tid med patienten. Slutsats Studien visar att kontinuitet är något som patienter upplever som viktigt när de möter vården men det saknas forskning om hur vården ska organiseras, för att kontinuiteten ska upplevas bättre ur ett patientperspektiv, balanserat mot organisationens behov av att spara tid och pengar.

Straddling the pathway from paediatrician to mainstream health care : transition issues experienced in disability care

Objective: To identify the strengths and limitations of health care and related services provided to young adults with a disability during the period of transition from the care of a paediatrician to the mainstream health system.
Design: A descriptive design was used to address the study objectives.
Setting: Barwon and south-western region of Victoria.
Subjects: Twelve focus group discussions, with young adults with a disability, carers of young adults with a disability and health care service providers. Each focus group involved eight to 10 participants.
Results: The findings revealed a number of problems with the transition period. All participants acknowledged the supportive, coordinating role of the paediatrician. In the absence of this type of role, carers felt they lacked the knowledge and support to manage the adolescent with a disability. Communication problems between all service providers were identified as being problematical. The general lack of continuity of care between providers made it difficult for individuals to negotiate the transition period and increased the burden of care on carers.
Conclusion: There is a need for policy makers to address these transition problems and develop appropriate services that improve the situation for young adults with a disability and their carers.
What is already known: It is well documented that the transition period from paediatrician to adult health care services is problematic for the young adult with a disability and their carer. The difficulties experienced are attributed to poor communication between service providers and a lack of continuity of care.
What does this study add: This study provides insights from a number of different consumer and health care professionals' perspectives. The findings identify service delivery gaps and a need to develop health care services that could assist the young adult with the disability negotiate this transition from the paediatric services to mainstream health care services in rural and regional settings in Victoria.

How do critical care nurses define the discharge planning process?

Background: Professional, political and organisational factors have focused attention on the discharge planning process in the Victorian health care sector. Discharge planning for patients, as part of continuity of care, is seen as a key concept in the delivery of nursing care. However, there is no question that discharge planning has emerged as a complex area of practice, and is, perhaps, most complex in the critical care area.

Aim: The study reported here is part of a larger thesis exploring critical care nurses’ perceptions and understanding of the discharge planning process in the health care system in the state of Victoria, Australia. As part of the survey participants were asked to define discharge planning as it related to the critical care environment in which they worked.

Methods: Utilising an exploratory descriptive approach, 502 Victorian critical care nurses were approached to take part in the study. The resultant net total of 218 participants completed the survey, which represented a net response rate of 43.4%. The data were analysed using quantitative and qualitative methodologies.

Findings: Three common themes emerged. A significant number of participants did not believe that discharge planning occurred in critical care, and therefore, thought that they could not provide a definition. There was uncertainty as to what the discharge planning process actually referred to in terms of discharge from critical care to the general ward or discharge from the hospital. There was an emphasis on movement of the patient to the general ward, which was considered in three main ways by first, getting the patient ready for transfer; second, ensuring a smooth transition to the ward and third, transfer of the patient to the ward often occurred because the critical care bed was needed for another patient.

Conclusion: The findings presented here suggest at a nursing level, the discharge planning process is not well understood and some degree of mutual exclusivity still remains. There is a need for further education of critical care nurses with regard to the underlying principles of the discharge planning process.

University planning and design under confucianism, colonialism, communism and capitalism : the Vietnamese experience

The university in Vietnam represents a thread of continuity that has managed to survive the political, economic and social turmoil faced so frequently by the Vietnamese people. This paper traces the evolution of the Vietnamese university in terms of its site planning and building design from the Hanoi Van Mieu, a Confucian 'temple of literature' which, built in 1070AD, is regarded as the country's first university, to today’s system of general and specialised universities and polytechnic institutions. In the late 1990s another step in the process of evolution began with the rationalization and amalgamation of the tertiary system to form two large, multi-campus and multi-disciplinary universities – the Hanoi National University and the Ho Chi Minh National University.

Porous titanium with porosity gradients for biomedical applications

Highly porous titanium and titanium alloys with an open cell structure are promising implant materials due to their low elastic modulus, excellent bioactivity, biocompatibility and the ability for bone regeneration. However, the mechanical strength of the porous titanium decreases dramatically with increasing porosity, which is a prerequisite for the ingrowth of new bone tissues and vascularization. In the present study, porous titanium with porosity gradients, i.e. solid core with highly porous outer shell was successfully fabricated using a powder metallurgy approach. Satisfactory mechanical properties derived from the solid core and osseointegration capacity derived from the outer shell can be achieved simultaneously through the design of the porosity gradients of the porous titanium. The outer shell of porous titanium exhibited a porous architecture very close to
that of natural bone, i.e. a porosity of 70% and pore size distribution in the range of 200 - 500 μm. The peak stress and the elastic modulus of the porous titanium with a porosity gradient (an overall porosity 63%) under compression were approximately 152 MPa and 4 GPa, respectively. These
properties are very close to those of natural bone. For comparison, porous titanium with a uniform porosity of 63% was also prepared and haracterised in the present study. The peak stress and the elastic modulus were 109 MPa and 4 GPa, respectively. The topography of the porous titanium
affected the mechanical properties significantly.

Toughened electrospun nanofibers from crosslinked elastomer-thermoplastic blends

A crosslink-able elastomeric polyester urethane (PEU) was blended with a thermoplastic, polyacrylonitrile (PAN), and electrospun into nanofibres. The effects of the PEU/PAN ratio and the crosslinking reaction on the morphology and the tensile properties of the as-spun fibre mats were investigated. With the same overall polymer concentration (9 wt %), the nanofibre containing higher composition of PEU shows a slight decrease in the average fibre diameter, but the tensile strength, the elongation at break and tensile modulus of the nanofibre mats are all improved. These tensile properties are further enhanced by slight crosslinking of the PEU component within the nanofibres.

COSMOS: COmparing standard maternity care with one-to-one midwifery support: a randomised controlled trial

Background: In Australia and internationally, there is concern about the growing proportion of women giving birth by caesarean section. There is evidence of increased risk of placenta accreta and percreta in subsequent pregnancies as well as decreased fertility; and significant resource implications. Randomised controlled trials (RCTs) of continuity of midwifery care have reported reduced caesareans and other interventions in labour, as well as increased maternal satisfaction, with no statistically significant differences in perinatal morbidity or mortality. RCTs conducted in the UK and in Australia have largely measured the effect of teams of care providers (commonly 6–12 midwives) with very few testing caseload (one-to-one) midwifery care. This study aims to determine whether caseload (one-to-one) midwifery care for women at low risk of medical complications decreases the proportion of women delivering by caesarean section compared with women receiving 'standard' care. This paper presents the trial protocol in detail.

Methods/design: A two-arm RCT design will be used. Women who are identified at low medical risk will be recruited from the antenatal booking clinics of a tertiary women's hospital in Melbourne, Australia. Baseline data will be collected, then women randomised to caseload midwifery or standard low risk care. Women allocated to the caseload intervention will receive antenatal, intrapartum and postpartum care from a designated primary midwife with one or two antenatal visits conducted by a 'back-up' midwife. The midwives will collaborate with obstetricians and other health professionals as necessary. If the woman has an extended labour, or if the primary midwife is unavailable, care will be provided by the back-up midwife. For women allocated to standard care, options include midwifery-led care with varying levels of continuity, junior obstetric care and community based general medical practitioner care. Data will be collected at recruitment (self administered survey) and at 2 and 6 months postpartum by postal survey. Medical/obstetric outcomes will be abstracted from the medical record. The sample size of 2008 was calculated to identify a decrease in caesarean birth from 19 to 14% and detect a range of other significant clinical differences. Comprehensive process and economic evaluations will be conducted.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012607000073404.

Natural rubber nanocomposite reinforced with nano silica

Inorganic nano fillers have demonstrated great potential to enhance the properties of natural rubber (NR). The present article reports the successful development of a NR nanocomposite reinforced with nano silica (SiO2). Its dynamic mechanical properties, thermal aging resistance, and morphology are investigated. The results show that the SiO2 nanoparticles are homogenously distributed throughout the NR matrix in a form of spherical nano-cluster with an average size of 80 nm when the SiO2 content is 4 wt%. With the introduction of SiO2, the thermal resistance and the storage modulus of NR host significantly increase, and the activation energy of relaxation of the nanocomposite, compared to the raw NR, increases from 90.1 to 125.8 kJ/mol.

Victorianisms in twentieth century young adult fiction

Abstract: This thesis investigates the origins of contemporary fictional constructions of childhood by examining the extent to which current literary representations of children and childhood have departed from their Victorian origins. I set out to test my intuition that many contemporary young adult novels perpetuate Victorian ideals and values in their constructions of childhood, despite the overt circumstantial modernity of the childhoods they represent. The question this thesis hopes to answer therefore is, how Victorian is contemporary young adult fiction? To gauge the degree of change that has taken place since the Victorian period, differences and points of continuity between representations of nineteenth century childhood and twentieth century childhood will be sought and examined in texts from both eras. The five aspects of fictional representation that I focus on are: notions of innocence; sexuality; the child as saviour; the use of discipline and punishment to create the ideal child; and the depiction of childhood and adulthood as separate worlds. The primary theoretical framework used derives from Michel Foucault’s concepts of the construction of subjectivity through discourse, discipline and punishment, and his treatment of repression and power, drawn mainly from The History of Sexuality vol. 1 (1976) and Discipline and Punish; the Birth of the Prison (1977). I have chosen to use Foucault primarily because of the affinity between his work on the social construction of knowledge and the argument that childhood is a constructed rather than essential category; and because Foucault’s work on Victorian sexuality exposes links with current thinking rather than perpetuating assumptions about sexual repression in this period.

Ti6Ta4Sn alloy and subsequent scaffolding for bone tissue engineering

Porous titanium (Ti) and titanium alloys are promising scaffold biomaterials for bone tissue engineering, because they have the potential to provide new bone tissue ingrowth abilities and low elastic modulus to match that of
natural bone. In the present study, a new highly porous Ti6Ta4Sn alloy scaffold with the addition of biocompatible alloying elements (tantalum (Ta) and tin (Sn)) was prepared using a space-holder sintering method. The
strength of the Ti6Ta4Sn scaffold with a porosity of 75% was found to be significantly higher than that of a pure Ti scaffold with the same porosity. The elastic modulus of the porous alloy can be customized to match that of
human bone by adjusting its porosity. In addition, the porous Ti6Ta4Sn alloy exhibited an interconnected porous structure, which enabled the ingrowth of new bone tissues. Cell culture results revealed that human SaOS₂
osteoblast-like cells grew and spread well on the surfaces of the solid alloy, and throughout the porous scaffold. The surface roughness of the alloy showed a significant effect on the cell behavior, and the optimum surface
roughness range for the adhesion of the SaOS2 cell on the alloy was 0.15 to 0.35 mm. The present study illustrated the feasibility of using the porous Ti6Ta4Sn alloy scaffold as an orthopedic implant material with a special
emphasis on its excellent biomechanical properties and in vitro biocompatibility with a high preference by osteoblast-like cells.

Spherulitic networks : from structure to rheological property

A finite element method based on ABAQUS is employed to examine the correlation between the microstructure and the elastic response of planar Cayley treelike fiber networks. It is found that the elastic modulus of the fiber network decreases drastically with the fiber length, following the power law. The power law of elastic modulus G′ vs the correlation length ξ obtained from this simulation has an exponent of −1.71, which is close to the exponent of −1.5 for a single-domain network of agar gels. On the other hand, the experimental results from multidomain networks give rise to a power law index of −0.49. The difference between −1.5 and −0.49 can be attributed to the multidomain structure, which weakens the structure of the overall system and therefore suppresses the increase in G′. In addition, when the aspect ratio of the fiber is smaller than 20, the radius of the fiber cross-section has a great impact on the network elasticity, while, when the aspect ratio is larger than 20, it has almost no effect on the elastic property of the network. The stress distribution in the network is uniform due to the symmetrical network structure. This study provides a general understanding of the correlation between microscopic structure and the macroscopic properties of soft functional materials.

Biodegradable Mg-Zr-Ca alloys for bone implant materials

Mg–Zr–Ca alloys were developed for new biodegradable bone implant materials. The microstructure and mechanical property of the Mg–xZr–yCa [x=0·5, 1·0% and y=1·0, 2·0% (wt-% hereafter)] alloys were characterised by optical microscopy, compressive and hardness tests. The in vitro cytotoxicity of the alloys was assessed using osteoblast-like SaOS₂ cells. The corrosion behaviour of these alloys was evaluated by soaking the alloys in simulated body fluid (SBF) and modified minimum essential medium (MMEM). Results indicated that the mechanical properties of the Mg–Zr–Ca are in the range of the mechanical properties of natural bone. The corrosion rate and biocompatibility decreases with the increase in the Ca content in the Mg–Zr–Ca alloys. The solutions of SBF and MMEM with the immersion of the Mg–Zr–Ca alloys show strong alkalisation. The Zr addition to the Mg–Zr–Ca alloys leads to an increase in the corrosion resistance, compressive strength and the ductility of the alloys, and a decrease in the elastic modulus of the Mg–Zr–Ca alloys.

A internacionalização da publicidade brasileira - 1970/2002

O processo de globalização da economia tem moldado um cenário complexo e desafiante para o setor publicitário brasileiro. A fusão e incorporação entre agências, com a absorção de muitas por grandes grupos de comunicação, é uma das mais visíveis transformações estruturais desde a década de 1980. O presente estudo investigou as seguintes questões: o impacto da internacionalização da publicidade brasileira nas relações entre as agências, anunciantes e veículos de comunicação; como as agências brasileiras têm ajustado seu modo de operação e competição, visando vantagem competitiva e lucratividade; as alternativas de continuidade das agências brasileiras diante da transmissão do poder aos sucessores legais e das propostas de fusão ou incorporação de grupos estrangeiros. Este estudo se insere na linha de pesquisa "Estudos da Cultura e do Consumo", desenvolvida pelo CECC - Centro de Estudos da Cultura e do Consumo, da EAESP/FGV.

Espelhos partidos : leituras e releituras da lenda heróica dos atridas

O trabalho foi desenvolvido analisando-se a lenda heróica da família dos Atridas, através da trilogia grega Orestéia, de Ésquilo, relacionando-a com Les mouches, de Sartre, e com Électre, de Giraudoux, comparando-as também com as duas Electra, a de Sófocles e a de Eurípides, partindo da análise do “texto como produtividade”, segundo Roland Barthes, que trabalha a reescritura do texto realizada pelo leitor. Os textos escolhidos foram produzidos e encenados em momentos de guerra ou de sua iminência e, através do estudo dos ordenamentos jurídicos vigentes em cada época, foi possível comprovar que, na Atenas do século V, ocorre a construção do conceito de responsabilidade individual, superando-se a imposição da punição aos familiares e à descendência do criminoso, enquanto que na França ocupada pelo exército nazista ocorre o inverso: a responsabilidade pelos assassinatos cometidos pela Resistência é atribuída a toda a comunidade. Confrontamos as relações de poder engendradas e expostas nos textos, refletindo as que estavam ocorrendo no contexto histórico-político, concluindo que a tragédia grega se inseriu como mediadora da realidade político-social da polis, ao contrário das releituras francesas, que tinham uma inserção periférica na sociedade francesa de 1937 a 1944. É em busca de um sentimento de continuidade e de transcendência que ocorre o retorno às tragédias gregas e às suas releituras, visto que narram lendas heróicas que relembram, mesmo ao homem do século XXI, sua mortalidade e sua incapacidade de prever os desdobramentos de suas ações.

A experiência de planejamento e orçamento em uma autarquia federal. O caso da CVM - comissão de valores imobiliários

o objetivo principal deste estudo de caso, está centrado na busca da identificação das influências que exercem as restrições orçamentárias no planejamento estratégico da CVM. Através deste trabalho tentaremos identificar a relação entre os planejamentos feitos pela instituição e a sua operacionalização. Consequentemente, os desafios que a instituição enfrentou, buscando alcançar seus objetivos e cumprir sua missão, tendo como pano de fundo, a relação entre o planejamento e os escassos recursos orçamentários. Consideramos que as referências bibliográficas utilizadas, são suficientes para suportar as análises e o entendimento do estudo. Analisaremos os planejamentos efetuados juntamente com os orçamentos propostos e autorizados, num período fragmentado, ano após ano. Tal fragmentação não prejudicará a visualização de continuidade das ações que foram implementadas ao longo do tempo. Tão importante quanto o estudo acima mencionado, será evidenciar detalhadamente a importância do papel do Estado, promovendo o desenvolvimento do mercado, através de suas ações, em uma política de regulação voltada para o cliente cidadão.