Surviving sepsis campaign in Brazil

Severe sepsis and septic shock have long been a challenge in intensive care because of their common occurrence, high associated costs of care, and significant mortality. The Surviving Sepsis Campaign (SSC) was developed in an attempt to address clinical inertia in the adoption of evidence-based strategies. The campaign relies on worldwide support from professional societies and has gained consensus on the management of patients with severe sepsis. The guidelines have subsequently been deployed into two bundles, with each bundle component sharing a common relationship in time. The widespread adoption of such evidence-based practice in clinical care has been disappointingly slow despite the quantifiable benefits regarding mortality. In Brazil, a country of continental dimensions with a heterogeneous population and unequal access to health services, this reality is no different. From 2004 to 2007, four prospective studies were published describing the country`s reality. In the multicenter Promoting Global Research Excellence in Severe Sepsis (PROGRESS) Study, the in-hospital mortality rate was higher in Brazil when compared with other countries: 56% against 30% in developed countries and 45% in other developing countries. During these 2.5 years of the campaign in Brazil, 43 hospitals have been receiving the necessary training to put in practice the recommended measures in all Brazilian regions, except for the North. The idea of the campaign is based on a 25% reduction in the relative risk of death from severe sepsis and septic shock within 5 years in the SSC-participating Brazilian hospitals. Ideally, the mortality rate should come to a 41.2% level subject to the 2009 deadline. This article aims to describe the actual scenario of the SSC implementation in Brazilian institutions and to report on some initiatives that have been used to overcome barriers.

Error in body weight estimation leads to inadequate parenteral anticoagulation

Parenteral anticoagulation is a cornerstone in the management of venous and arterial thrombosis. Unfractionated heparin has a wide dose/response relationship, requiring frequent and troublesome laboratorial follow-up. Because of all these factors, low-molecular-weight heparin use has been increasing. Inadequate dosage has been pointed out as a potential problem because the use of subjectively estimated weight instead of real measured weight is common practice in the emergency department (ED). To evaluate the impact of inadequate weight estimation on enoxaparin dosage, we investigated the adequacy of anticoagulation of patients in a tertiary ED where subjective weight estimation is common practice. We obtained the estimated, informed, and measured weight of 28 patients in need of parenteral anticoagulation. Basal and steady-state (after the second subcutaneous shot of enoxaparin) anti-Xa activity was obtained as a measure of adequate anticoagulation. The patients were divided into 2 groups according the anticoagulation adequacy. From the 28 patients enrolled, 75% (group 1, n = 21) received at least 0.9 mg/kg per dose BID and 25% (group 2, n = 7) received less than 0.9 mg/kg per dose BID of enoxaparin. Only 4 (14.3%) of all patients had anti-Xa activity less than the inferior limit of the therapeutic range (<0.5 UI/mL), all of them from group 2. In conclusion, when weight estimation was used to determine the enoxaparin dosage, 25% of the patients were inadequately anticoagulated (anti-Xa activity <0.5 UI/mL) during the initial crucial phase of treatment. (C) 2011 Elsevier Inc. All rights reserved.

Audiology in Brazil

The profession of audiology took root in Brazil nearly a half a century ago and has since blossomed into a flourishing, well-developed field. Currently, audiologists in Brazil work at private institutions, including private medical practices and dedicated speech and hearing clinics. They are also employed in a wide array of public institutions, including community clinics, elementary schools, colleges, and universities. In both the private sector and health clinics, audiologists perform diagnostic evaluations of auditory and vestibular disorders, select and fit hearing aids, and provide aural rehabilitation. At the public level, they assist with workers` health programs, dispense hearing aids, and aural rehabilitation. There is always room to grow, however, and the future of audiology in Brazil holds both challenges and opportunity. The following article will sketch the development of audiology training and practice in Brazil, provide a picture of how the field stands today, and summarize the unique challenges which the profession faces in this large and diverse nation.

Research output of Australian general practice: A comparison with medicine, surgery and public health

Objectives: To compare the productivity of Australian general practice in terms of research publications with the productivity of other medical disciplines. Design: A survey of Australian general practice, medicine, surgery and public health publications carried out by manual searching of specific journals and an electronic search of the US National Library of Medicine's PubMed database. Main outcome measures: The number of original research publications by Australian general practitioners, physicians, surgeons and public health physicians during 1999; the relative publication rate of Australian general practice, medicine, surgery and public health over the period 1990-1999. Results: Of original research articles published in 1999, GPs authored 65% (17/26) in Australian Family Physician and 3% (3/90) in the Medical Journal of Australia; physicians published 4% and 37%, respectively. The electronic search identified 54 research articles relating to Australian general practice published in 1999 in 21 different journals, only two of which were primary care journals. Over the period 1990-1999, there was a publication rate of one general practice [discipline] article per 1000 GPs in practice per year. Corresponding rates for medicine, surgery and public health were 105/1000, 61/1000 and 148/1000, respectively. Conclusions: There is considerable disparity between the level of research output of general practice and that of the disciplines of medicine, surgery and public health. If we are to have effective general practice research, we urgently need to develop research skills, a supportive infrastructure and a culture that nurtures research.

Transformational leadership, corporate cultism and the spirituality paradigm: An unholy trinity in the workplace?

Leadership is a perennially popular topic in the academic and practitioner literature on management. In particular, the past twenty years have witnessed an explosive growth of interest in what has been termed 'transformational leadership' (henceforth, TL). The theory is closely linked to the growth in what has been defined as corporate culturism - an emphasis on the importance of cohereat cultures, as a means of securing competitive advantage. This article outlines the central components of TL theory, and subjects the concept to a critical analysis. In particular, similarities are identified between the components concerned and the characteristics of leadership practice in organizations generally defined as cults. This connection has been previously unremarked in the literature. These similarities are comprehensively reviewed. Trends towards what can be defined as corporate cultism in modem management practice are also discussed. We conclude that TL models are overly concerned with the achievement of corporate cohesion to the detriment of internal dissent Such dissent is a vital ingredient of effective decision-making. It is suggested that more inclusive and participatory models of the leadership process are required.

Survivors and victims: A case study of organisational restructuring in the public health sector

This paper examines a process of major organizational restructuring in an Australian hospital within a context of decentralization of health services and relocation of clients, brought about by changes in government policy. The change process differed from the abrupt downsizing often found in the private sector in that the organization initiated significant job losses concomitantly with the development of new facilities around the State, while attempting to deal with employee issues related to downsizing. The paper focuses on the process involved in the downsizing, from the perspective of both the "survivors" and "victims" of the change. It draws on interviews and focus groups with managers, union officials and employees, as well a survey of employees to assess the outcomes and effectiveness of the restructuring process. Using a stakeholder analysis framework, the paper examines the complex issues and perspectives raised by the downsizing process.

Psychologists as mental health case managers

The results of two independent surveys of professionals working in government-funded adult community mental health services were examined with a view to considering how psychologists rate their capacities as mental health case managers. Professional competency and personal efficacy self-report profiles for psychologists were compared with those of other professionals in related roles. The results obtained suggested that psychologists identified their strengths as being in traditional practice roles as individual clinicians. Relative to other professions, psychologists reported weaknesses in team and community-focused practice roles. The implications for professional practice and training are discussed.

An overview of APSIM, a model designed for farming systems simulation

The Agricultural Production Systems Simulator (APSIM) is a modular modelling framework that has been developed by the Agricultural Production Systems Research Unit in Australia. APSIM was developed to simulate biophysical process in farming systems, in particular where there is interest in the economic and ecological outcomes of management practice in the face of climatic risk. The paper outlines APSIM's structure and provides details of the concepts behind the different plant, soil and management modules. These modules include a diverse range of crops, pastures and trees, soil processes including water balance, N and P transformations, soil pH, erosion and a full range of management controls. Reports of APSIM testing in a diverse range of systems and environments are summarised. An example of model performance in a long-term cropping systems trial is provided. APSIM has been used in a broad range of applications, including support for on-farm decision making, farming systems design for production or resource management objectives, assessment of the value of seasonal climate forecasting, analysis of supply chain issues in agribusiness activities, development of waste management guidelines, risk assessment for government policy making and as a guide to research and education activity. An extensive citation list for these model testing and application studies is provided. Crown Copyright (C) 2002 Published by Elsevier Science B.V. All rights reserved.

Systematic review of the role of pre-oxygenation for tracheal suctioning in ventilated newborn infants

Pre-oxygenation for endotracheal suctioning for mechanically ventilated infants is routine practice in many neonatal intensive care units. In the present systematic review the evidence to support its use is discussed and the authors conclude that no confident recommendations can be made from the results of this review.

Conselhos municipais de pol??ticas p??blicas: uma an??lise explorat??ria

Os Conselhos Gestores s??o f??runs h??bridos onde se viabiliza a participa????o popular no desenho das pol??ticas p??blicas, nas negocia????es de interesses da coletividade, na elabora????o de programas e projetos sociais e na fiscaliza????o das a????es governamentais. O significado e a dimens??o dos Conselhos para a democracia participativa s??o enormes, justificando a import??ncia da realiza????o deste estudo, que se baseou na an??lise explorat??ria de 12 Conselhos locais do munic??pio mineiro de Vi??osa, com o objetivo de avaliar o desempenho dos mesmos. A avalia????o do desempenho levou em considera????o os mesmos par??metros dimensionais, tanto para a coleta de dados prim??rios quanto para a coleta secund??ria. A coleta de dados prim??rios foi realizada a partir da aplica????o de question??rios semi-estruturados aos presidentes dos Conselhos em an??lise. Utilizou-se o programa SPSS, vers??o 15.0, para an??lise estat??stica das quest??es objetivas dos question??rios e a t??cnica de an??lise de conte??do para exame das quest??es abertas. Ap??s essa etapa, realizou-se um workshop com os presidentes dos Conselhos, visando ?? obten????o de novos dados e informa????es. Os Conselhos municipais analisados apresentaram resultados pouco discrepantes entre a teoria aplicada ao tema e a sua efetiva pr??tica no campo p??blico. Contudo, a pesquisa revelou que o grau de desenvolvimento institucional dos Conselhos n??o ?? homog??neo, ou seja, h?? alguns melhores gestores que outros. A escolha independente e democr??tica dos membros n??o-governamentais dos Conselhos em Vi??osa revelou o seu grau de independ??ncia do Poder Executivo. Por??m, a capacita????o de conselheiros precisa ser implementada para evitar uma desfigura????o dos Conselhos. No que tange ?? governan??a, destacouse em Vi??osa o seu grau e formas de aplicabilidade observadas na gest??o de v??rias pol??ticas. Da mesma forma, foi observado um n??vel de governabilidade que confere legitimidade ??s pol??ticas implementadas. Por fim, verificou-se que a efetividade da accountability societal tem sido instrumentalizada pelos Conselhos no ??mbito das diversas pol??ticas setoriais. J?? os dados secund??rios da an??lise foram obtidos por meio das s??nteses dos relat??rios de fiscaliza????o de munic??pios do Estado de Minas Gerais, realizadas pela Controladoria Geral da Uni??o. Foram identificados todos os registros pertinentes aos Conselhos Gestores Municipais do Estado de Minas Gerais, no per??odo de 2003 a 2006. Verificou-se que os maiores problemas se referem aos Conselhos Municipais de Sa??de e Assist??ncia Social. Entre as in??meras falhas apontadas, destacam-se problemas graves na constitui????o e operacionaliza????o dos Conselhos, resultando na inoper??ncia desses mecanismos nos munic??pios fiscalizados. A avalia????o do desempenho dos Conselhos locais de Vi??osa possibilitou concluir que esses mecanismos apresentaram um desempenho bem satisfat??rio na gest??o e controle das pol??ticas p??blicas no munic??pio.

Contribution towards a reflection about methodological strategies in design education and the function of drawing in design

This work presents a reflection on Design education and specifically on the role of Drawing in this area. As a subject, Design has expanded its field of action expanding into new areas such as Experience Design or Service Design. It became necessary for the designer to have more than an education based on technological knowledge or know-how. Many authors like Meredith Davis, Don Norman or Jamie Hobson point out the urgency to review the curricula of Design courses because nowadays “… design is more than appearance, design is about interaction, about strategy and about services. Designers change social behavior” (Norman 2011). When shifting from a product-centered design to a person-centered design (in a structure, a service or in a relationship) what should the function of drawing in a design course be? What should its curriculum be? Our work methodology will be to confront today’s perspectives on design theory and practice in an attempt to add to the discussion on the methodological strategies in design teaching in the contemporary context.

Contribution towards a reflection about methodological strategies in Design Education and the function of Drawing in Design

This work presents a reflection on Design education and specifically on the role of Drawing in this area. As a subject, Design has expanded its field of action expanding into new areas such as Experience Design or Service Design. It became necessary for the designer to have more than an education based on technological knowledge or know-how. Many authors like Meredith Davis, Don Norman or Jamie Hobson point out the urgency to review the curricula of Design courses because nowadays “ … design is more than appearance, design is about interaction, about strategy and about services. Designers change social behavior” (Norman, 2011) When shifting from a product-centered design to a person-centered design (in a structure, a service or in a relationship) what should the function of drawing in a design course be? What should its curriculum be? Our work methodology will be to confront today’s perspectives on design theory and practice in an attempt to add to the discussion on the methodological strategies in design teaching in the contemporary context.

Offshore outsourcing in large companies: motivations and risks perceived

When companies opt for information systems (IS) outsourcing, within the set of contracted services, they can contract their entire service needs to onshore suppliers or to offshore companies, or part of these services can be contracted to onshore suppliers and the other part to offshore suppliers. The offshore outsourcing reveals itself nowadays as an important strategic option to IS management optimization. This paper presents and discusses the main results of a survey that was carried out in Portugal to determine several aspects of offshore practice in large companies. It allowed the identification of the services more frequently contracted, the most common motivations for choosing offshore suppliers and the main risks perceived by companies. This research contributes to a better understanding of the IS offshore market, enabling client companies and vendors to improve their strategic business action.

Agencification in Latin countries: Portugal

This chapter provides a broad look at the Portuguese process of agencification in the last two decades. As with most of the remaining chapters in this book, we cover the basics by describing the administrative landscape, its changes in organizational make-up, the delicate balance between control and autonomy in the ministry-agency relationship, perceptual changes in efficiency and performance measurement in public management, based on a comprehensive survey (COBRA survey of the CRIPO research group) sent to all public-sector organizations under public law with some degree of autonomy (see Chapter 1, Table 1.1). Portugal is undergoing the most pervasive politico-economic crisis in its short democratic history. The administrative mapping conducted in 2007 which served as the basis for the administration of the COBRA survey is already undergoing change.

Tribunal Constitucional: hora de cortar nas PPP’s, contratos futuros-swap…

Veja-se aliás a recente indagação formal da Procuradoria-Geral da República junto do Governo para colocar, se necessário for, em Tribunal, todos os contratos futuros swap. A maior parte dos quais com fortes prejuízos para o Estado português. Vide art.s 227º, 334º, 437º, 762º, entre outros, do Código Civil português. Abstract: See moreover the recent formal inquiry of the Attorney General's Office with the Government to place, if necessary, in court, all future swaps. Most of them with heavy losses to the Portuguese State. See art.s 227, 334, 437, 762º, among others, the Portuguese Civil Code.