Qualidade de vida de pessoas com úlceras venosas atendidos no ambulatório de um hospital universitário

Descriptive study aimed to analyze the quality of life (QOL) of patients with venous ulcers (UV) outpatient clinic of a university hospital in Natal / RN. The aim of the study population was composed of 50 patients with UV treated at the cardiology clinic of a university teaching hospital at the tertiary level. The study was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (Protocol 279/09). Data collection was performed over a period of two months by the very a masters degree and an academic nursing through the application of a form concerning the socio-demographic, clinical, and health care, and the instruments WHOQOL and WHOQOL - old. The data were analyzed with SPSS 15.0, using descriptive and inferential statistics presented in the form of tables, charts and graphs. Of the surveyed, female predominance, age range 59 years, Catholic, low education, married, with up to 03 children, not working, retired, or with occupations requiring long periods in one position, wage income of up to 02 minimum wages, inadequate sleep, patients with chronic venous insufficiency and other chronic diseases such as diabetes and hypertension, were taking medications for treatment, being a minority to IVC. In patients with predominant only one injury, time of injury up to five years, inadequate rest, pain, edema and lesions colonized. The assistance the UV patients began treatment of the injury until four months after the onset of the ulcer, and services primary health care most wanted, access to angiologist by reference form, commuted by public transportation, received support regarding the treatment of injuries. The topical product most used in the lesion was healing, and few were using compression therapy. respondents suffer discrimination in society, showed changes in quality of life after the occurrence of ulcer in relation to leisure, pain, restriction of social / school / transportation; barring employment / financial / social ladder; Physical appearance / discrimination and restriction of domestic activity. These changes were related to the time of injury and found that the more chronic injury is the most negative changes occur in their QV (ρ = 0.000). Analyzing the characteristics of QV measured by the WHOQOL-bref, we found for the two general questions they are dissatisfied with their health (ρ = 0.023) and all areas have significant difference compared with the worst QV have the injury of more than 5 years (ρ = 0.000). The QV measured by the WHOQOL-old, we found that these patients had no changes from the time of injury. We conclude that the QV of patients with UV was considered unsatisfactory when compared to the time of injury on more than 5 years which shows that the quality of life worsens with time the chronic UV.

Análise de qualidade da atenção à criança na estratégia saúde da família: o óbito infantil evitável como referência

Alma-Ata declaration bring the Primary Attention to the Health (PAH) as first level of health attention for individuals, family and community, which considers infant group as priority. Several initiatives that gave bases to integral attention to the children health formalized in the principles of Unique Health System. Family Health Strategy (FHS) comes to strengthen this attention, instituting new ways of work organization and professional practices that gave impact in their quality indicators. One of them is children mortality, showing decline in their values. Though, studies indicates persistence of avoidable infant deaths. In Natal RN, this reality is also perceptible leading to inquietudes, mainly at the space of services production, it means, which motivated the accomplishment of the present study intending to analyse the way that the organizational and structural processes as long as the professional practices in FHS interfered in the quality of children s health attention who died by avoidable death in the year of 2007 in municipal district of Natal-RN. It treats, therefore, to an exploratory and descriptive survey of cases study type, thar had as primary sources the oficial documents of MH, the family prontuary, pregnant card, child card and testimony obt ined from instrument of research elaborated based in investigation form of infant death by MH, applied to 10 mothers of children who had avoidable death. In analysis it was appealed silmultaneous triangulation of methods and sources, allowing a bigger aproximation from obtained informations. To elucidate the cases, the aspects studied were analyzed to the light of explicative model of Social Determinants of Health. Among individual and family aspects were highlighted the related to age, schooling, family habits and customs and mother s economic condition, besides of pregnancy age, newborn weight and associated diseases, which don t differ from literature about the theme. Reffering to the factors organizational and structural processes and professionals practice, highlihgted, the treatment given by the professionals, the territorialization and adscription of areas, the difficulty of having access to the services or sleepers and the reference and counterreference. But also, the ausence or few greet, the lack of communication, few assiduity and ponctuality by professionals in service, among others. In a general way mothers considers the attendance received in the hospital good and very good , opnions that in the Basic Attention weren t so favorable, in spite of many of predictible actions in this level have been performed in the studied cases. It is observed, therefore, that the social determinants of health has a strong influence in ocurrence of infant deaths, what implicates in a large actuation by Infant Mortality Committee from municipal district. This way, it becomes fundamental the reflection and evaluation about the effectiveness and execution by the processes of vigilance to health in FHUs; the rethink about the social determinants of health in a wide and articulate way to the services quality, to permanent education, to management in service, to the given attention and to the way how it is installed the popular participation and social control. To the professionals it is presented the great challenge to review their daily practice, their values, behaviors and commitment, which ones must be guided by logical of sharing, work in team, humanescence and alterity, not only by the accomplishment of a professional duty

Evidências de validação de um protocolo para assistência às pessoas com úlceras venosas em serviços de alta complexidade

Venous ulcers are lesions resulting from chronic venous insufficiency, venous valvular abnormalities and venous thrombosis. Its occurrence has been growing with the increase in life expectancy of the world population. Considered as fundamental aspects in the approach to the person with venous ulcer care with the interdisciplinary approach, adoption of protocol-specific knowledge, technical skill, coordination between levels of care complexity of the Health System and active participation of patients and their families, a holistic perspective. The construction of a clinical protocol for people with venous ulcers can help professionals of high complexity services in patient assessment and the establishment of quality care in a systematic way and focused on the factors that interfere with wound healing. Thus, this study aimed to analyze the evidence of validation of a clinical protocol for people with venous ulcers treated at high-complexity services. This is a methodological study with a quantitative approach, developed in three stages: literature review, evidence of content validity and evidence of validation in the clinical context. Approved by the Federal University of Rio Grande do Norte Research Ethics Committee (Opinion: 147.452 and CAAE: 07556312.0.0000.5537). The literature review was conducted in August and September 2012, becoming the basis for the construction of the protocol. Then the evidence of content validity, which included 53 judges (experts) selected by the Lattes platform to evaluate the protocol items was performed. The judges were contacted by e-mail and rated the protocol via Google Docs . After analyzing the ratios obtained in this step, which reported kappa between 0.75 and 0.96 and between 0.80 and 0.98 IVC, and the suggestions of the judges, the protocol was adjusted and subjected to empirical evidence to validate the clinical setting at the University Hospital Onofre Lopes in Natal / RN. Evidence of validation in the clinical setting involved 4 judges who acted in pairs (paired) evaluated 32 patients with venous ulcers in the clinical context of high complexity. In both stages, we used the Kappa Index and Content Validity Index to analyze the responses of the judges. The parameters set as acceptable for these indices were: Kappa ≥ 0.61 and Content Validity Index > 0.80. Any evidence of content validity, as evidence of validation in the clinical context, the protocol items that have not reached Kappa and Content Validity Index established indices were excluded and some items were modified or added after suggestions. The process of content validation evidence and evidence of validation in the clinical setting allowed the improvement of the protocol for the care of people with venous ulcers initially proposed. The initial version of the protocol, built from the literature, contained 15 categories and 108 items; after evidence of content validity, remained the reduction to 15 categories with 91 items; the final version, clinically validated, is composed of the same 15 categories, 76 items. The protocol was validated in its content and in the clinical aspect, so we accepted the alternative hypothesis in the study. This protocol may contribute to the care system, allowing tailor behaviors and promote greater resolution in the treatment of people with venous ulcers in health services of high complexity

Uma proposta para preparação de pequenas e médias empresas brasileiras prestadoras de serviços ao setor de telecomunicações para implantação da metodologia Seis Sigma

The objective of this work consists of considering a script so that operating companies in the telecommunications sector, mainly small and medium-sized enterprises, can reach excellency in its operations and get, thus, conditions to compete with companies consolidated in its niche of market. The proposal intends to lead the enterprises to a level of qualification of processes that to become them apt to adopt the Six Sigma method as part of its culture. From the analysis of the essential processes of the sector, methods and tools will be suggested for guarantee the continuous improvement of these processes, without forgetting the internal peculiarities of each company

Análise dos indicadores de qualidade versus taxa de abandono utilizando método de regressão múltipla para serviço de banda larga

Telecommunication is one of the most dynamic and strategic areas in the world. Many technological innovations has modified the way information is exchanged. Information and knowledge are now shared in networks. Broadband Internet is the new way of sharing contents and information. This dissertation deals with performance indicators related to maintenance services of telecommunications networks and uses models of multivariate regression to estimate churn, which is the loss of customers to other companies. In a competitive environment, telecommunications companies have devised strategies to minimize the loss of customers. Loosing customers presents a higher cost than obtaining new ones. Corporations have plenty of data stored in a diversity of databases. Usually the data are not explored properly. This work uses the Knowledge Discovery in Databases (KDD) to establish rules and new models to explain how churn, as a dependent variable, are related to a diversity of service indicators, such as time to deploy the service (in hours), time to repair (in hours), and so on. Extraction of meaningful knowledge is, in many cases, a challenge. Models were tested and statistically analyzed. The work also shows results that allows the analysis and identification of which quality services indicators influence the churn. Actions are also proposed to solve, at least in part, this problem

Avaliação de economias de escala e escopo no desempenho de equipes de serviços aplicando Análise de Envoltória de Dados DEA: um estudo em Empresa de Telecomunicações no Brasil

This Master s Thesis proposes the application of Data Envelopment Analysis DEA to evaluate economies of scale and economies of scope in the performance of service teams involved with installation of data communication circuits, based on the study of a major telecommunication company in Brazil. Data was collected from the company s Operational Performance Division. Initial analysis of a data set, including nineteen installation teams, was performed considering input oriented methods. Subsequently, the need for restrictions on weights is analyzed using the Assurance Region method, checking for the existence of zero-valued weights. The resulting returns to scale are then verified. Further analyses using the Assurance Region Constant (AR-I-C) and Variable (AR-I-V) models verify the existence of variable, rather than constant, returns to scale. Therefore, all of the final comparisons use scores obtained through the AR-I-V model. In sequence, we verify if the system has economies of scope by analyzing the behavior of the scores in terms of individual or multiple outputs. Finally, conventional results, used by the company in study to evaluate team performance, are compared to those generated using the DEA methodology. The results presented here show that DEA is a useful methodology for assessing team performance and that it may contribute to improvements on the quality of the goal setting procedure.

Gestão ambiental na saúde pública: um estudo sobre a percepção ambiental de gerenciamento de resíduos sólidos de serviços de saúde, dos servidores do Hospital Universitário Onofre Lopes do Rio Grande do Norte

This research has aimed at studying the perception of University Hospital Onofre Lopes (HUOL) s workers on the environmental management plan of RSSS. They have been interviewed 250 workers: doctors, nurses, nursing assistants, and cleaners. It was used an exploratory and descriptive research of the type Survey, which aims at obtaining of data or information on characteristics, actions or opinions of any group of people. The questions of the questionnaire were of the kind objective", formulated in a model "scale", analyzed in according to the positioning of the interviewee. The wastes of health service have high potential for environmental impact in the activities from HUOL. Actions or environmental protective policy can improve the image of HUOL. They have been detected divergences on the rigor in application of law of ANVISA. The HUOL s workers unaware of the law of ANVISA and they have little or no knowledge about the practices of environmental control, public health and, they do not know the Environmental Management System ISO 14001. They have divergent views on the degree of importance of ISO 14001. There is not a Waste Management Plan for Health Service and / or is not disclosed for most of HUOL workers. It has not carried out audits or defined the goals and objectives. Besides, it has not been identified legal requirements, and there has not been communication about the service is performed or has been made a critical analysis and no control of documents the environmental management plan. The HUOL have not had a committee of environmental management. The direction of HUOL has not been organized courses, training and recycling of waste on environmental control of the health service. On a scale from 01 to 05, the level of aware level concerning to the waste management from health services of the workers, so is at the threshold between 01 and 02. For the reversal of this situation, the first and urgent step is the creation and institutionalization the environmental management committee of the University Hospital Onofre Lopes

Fatores da qualidade e satisfação na compra pela internet e sua influência na fidelidade dos consumidores

A presente pesquisa objetivou estudar as relações entre os fatores intervenientes para a satisfação no processo de compras baseadas na Internet e sua influência na fidelidade online (e-loyalty), na visão dos consumidores de varejo virtual. Para tanto, foi utilizado como instrumento de coleta de dados um questionário baseado em fatores de qualidade e fidelidade oriundos dos serviços convencionais, que foi adaptado para a realidade dos serviços digitais. A pesquisa caracteriza-se como exploratória, de natureza quantiqualitativa. A análise quantitativa descreveu e testou a relação de variáveis de qualidade do site e de preço dos produtos do site com as variáveis de satisfação. Neste caso, foram utilizadas técnicas estatísticas como distribuição de freqüência, médias e desvio-padrão e correlação de postos de Spearman. Já na abordagem qualitativa, foi empregada a análise de conteúdo para uma questão aberta relacionada com a identificação dos fatores que levam a fidelidade digital. A pesquisa de campo foi feita com uma amostra de 44 alunos de pós-graduação em nível de Especialização da Universidade Federal do Rio Grande do Norte. Os resultados da análise quantitativa evidenciaram que a qualidade está ligada à satisfação dos clientes em vários fatores, mas o preço não influencia muito na satisfação. Na análise qualitativa, a segurança do website e os preços oferecidos são fatores que potencialmente fidelizam os clientes digitais, segundo a perspectiva dos entrevistados. O fator segurança e confiança no website foi considerado o mais crítico para a fidelidade dos clientes que compram pela Internet

Qualidade do serviço de informação digital :um estudo exploratório em web sites de Programas de Pós-Graduação

This dissertation of Mestrado investigated the performance and quality of web sites. The target of the research is the proposal of an integrated model of evaluation of services of digital information in web educational sites. The universe of the research was constituted by eighteen Brazilian Universities that offer after-graduation courses, in the levels of mestrado and doutorado in the area of Engineering of Production. The adopted methodology was a descriptive and exploratory research, using the technique of systematic comment and focus group, for the collection of the data, using itself changeable independent dependents and, through the application of two instruments of research. The analysis protocol was the instrument adopted for evaluation and attainment of qualitative results. E the analysis grating was applied for evaluation and attainment of the quantitative results. The qualitative results had identified to the lack of standardization of web sites, under the attributes of content, hierarchy of information, design of the colors and letters. It of accessibility for carriers of auditory and visual special necessities was observed inexistence, as well as the lack of convergence of medias and assistivas technologies. The language of the sites also was evaluated and all present Portuguese only language. The general result demonstrated in grafico and tables with classification of the Universities, predominating the Good note As for the quantitative results, analysis method ed was estatistico, in order to get the descriptive and inferencial result between the dependent and independent variaveis. How much a category of analysis of the services of the evaluated sites, was found it props up and the index generality weighed. These results had served of base for ranking of existence or inexistence the Universities, how much of the information of services in its web sites. In analysis inferencial the result of the test of correlation or association of the independent variaveis (level, concept of the CAPES and period of existence of the program) with the caracteristicas, called was gotten categories of services. For this analysis the estatisticos methods had been used: coefficient of Spearman and the Test of Fisher. But the category you discipline of the Program of Mestrado presented significance with variavel independent and concept of the CAPES. Main conclusion of this study it was ausencia of satandardization o how much to the subjective aspects, design, hierarchy of information navigability and content precision and the accessibility inexistence and convergence. How much to the quantitative aspects, the information services offered by web sites of the evaluated Universities, still they do not present a satisfactory and including quality. Absence of strategies, adoption of tools web, techniques of institucional marketing and services that become them more interactive, navigable is perceived and with aggregate value

Fatores que afetam a satisfação de pacientes em serviços de saúde :um estudo em setor ambulatorial de hospital

This thesis shows concepts and models related to customer satisfaction measurement, focusing in detail on patients satisfaction evaluations in a policlinic sector of a hospital located in Natal RN. To reach this aim, two hundred and fifty one patients of this hospital were interviewed. The methodology approach includes a theoretical basis through a review and study of previous research on the topic, governmental initiatives and management systems which deal with excellence and need more reports concerning customers perceptions about satisfaction. Furthermore, it was included some models of nationals index about customer satisfaction. The Norwegian model was used in this thesis. The use of this approache, together with a multiple regression analysis, led to results that shows the factors which affect patients satisfaction in a policlinic sector. They are four as following: The evaluation of physician attendance; its results; simplicity of accessibility when health services are needed; and both support and tranquility given by the hospital. The study results can support researches of a conceptual model to determinate the aspects which affect the patient s satisfaction and could be a contribution to a development of a national costumer satisfaction index

Sistema de gestão da qualidade na hotelaria :um estudo comparativo da ISO 9000 com os modelos de classificação no Brasil

Este trabalho tem como objetivo estudar os sistemas de Classificações existentes para a garantia da gestão da qualidade no setor hoteleiro, tendo como foco principal a Matriz de Classificação para os Meios de Hospedagem da EMBRATUR e a ISO 9000, observando os benefícios que esses sistemas e/ou processos de gestão poderão vir a proporcionar para o setor hoteleiro no que se refere à qualidade de seus serviços. Para a obtenção dessas informações foi realizada uma análise comparativa dos sistemas de gestão da qualidade através de pesquisas bibliográficas e de questionários enviados para empreendimentos hoteleiros certificados e classificados, onde os principais resultados fornecidos pela pesquisa foram trabalhados de forma a apresentar, de maneira clara, a superioridade de um sistema em relação ao outro

Benefícios e dificuldades na adoção de um sistema de gestão da qualidade no Rio Grande do Norte

Taking competitive advantage or satisfy the client are the reasons why companies have been implementing a Quality Management System (QMS). It brings benefits such as the improvement in the processes, products and services; an enhancement in the image of the company (marketing) and satisfaction of the clients. As a whole, this paper aims to evaluate the results obtained from the implementation of the QMS in the certified companies in the ISO 9001 standard, contained in the database of INMETRO, of the Rio Grande do Norte State (RN). In order to achieve the goals, a bibliographical research about the theme quality management system was made and, subsequently a survey was made with the managers of the certified companies in RN, using the online questionnaire. Out of 27 companies that have the certificate in Rio Grande do Norte, 21 responded the data collection instrument. The data analysis was made through techniques of descriptive and multivariate statistics: cluster analysis. The research instrument used contained 20 questions that address the main theme of this dissertation. Using the cluster analysis, four groupings that possessed similarities concerning the survey answers were found. This analysis allowed us to conclude that the QMS boosts significant improvements in the organizations, such as: quality in the reputation of the company and sales increase. On the other hand, it allowed us to identify as main difficulties: the dissemination of the quality culture, lack of commitment of the whole organization and the resistance of the workers

Fatores condicionantes da utilização da Internet na compra de serviços de viagens e turismo: estudo com turistas brasileiros em visita à Natal-RN

In today s global society, companies have become even more competitive with the abundance of information that prospective clients have available to them. This way the tourist services has appropriate the distribution using electronics ways as information for doing acquirement services. This work, shows the adopted provision of on-line tourist services does have suited apportionment for factors and buy decisions. The method used is a survey applied to the tourists, at international airport Augusto Severo, no matter why the visit reason to Natal city, at all, they were 210 people, being the chief variables evaluated the tourist perception of facility, utility, benefits, amenity and pleasure from the Internet s use, under the terms at the tourists experiences from the WEB about to acquisitions and researches. The results acquaint that the younger tourists or less experts tourists, in visit to Natal, demonstrated greater bias to the Internet s use than the other people. By the way women have a larger representation as a consumer from the WEB and finally, people along greater study tends to adopt. The work s contribution provides greater knowledge for the tourism executives about how might use the Internet, as well as bring forward a scene propitious for the on-line diffuseness service

Modelagem de equações estruturais na análise de dados de serviços em comunicações móveis

In recent decades, changes have been occurring in the telecommunications industry, allied to competition driven by the policies of privatization and concessions, have fomented the world market irrefutably causing the emergence of a new reality. The reflections in Brazil have become evident due to the appearance of significant growth rates, getting in 2012 to provide a net operating income of 128 billion dollars, placing the country among the five major powers in the world in mobile communications. In this context, an issue of increasing importance to the financial health of companies is their ability to retain their customers, as well as turn them into loyal customers. The appearance of infidelity from customer operators has been generating monthly rates shutdowns about two to four percent per month accounting for business management one of its biggest challenges, since capturing a new customer has meant an expenditure greater than five times to retention. For this purpose, models have been developed by means of structural equation modeling to identify the relationships between the various determinants of customer loyalty in the context of services. The original contribution of this thesis is to develop a model for loyalty from the identification of relationships between determinants of satisfaction (latent variables) and the inclusion of attributes that determine the perceptions of service quality for the mobile communications industry, such as quality, satisfaction, value, trust, expectation and loyalty. It is a qualitative research which will be conducted with customers of operators through simple random sampling technique, using structured questionnaires. As a result, the proposed model and statistical evaluations should enable operators to conclude that customer loyalty is directly influenced by technical and operational quality of the services offered, as well as provide a satisfaction index for the mobile communication segment

Estudo da qualidade de serviço de uma aplicação VoIP em ambientes wireless com handoff

This work deals with experimental studies about VoIP conections into WiFi 802.11b networks with handoff. Indoor and outdoor network experiments are realised to take measurements for the QoS parameters delay, throughput, jitter and packt loss. The performance parameters are obtained through the use of software tools Ekiga, Iperf and Wimanager that assure, respectvely, VoIP conection simulation, trafic network generator and metric parameters acquisition for, throughput, jitter and packt loss. The avarage delay is obtained from the measured throughput and the concept of packt virtual transmition time. The experimental data are validated based on de QoS level for each metric parameter accepted as adequated by the specialized literature