Barreiras e facilitadores à prática do acompanhamento farmacoterapêutico nos serviços farmacêuticos hospitalares portugueses

Objectivos: Identificar e compreender as barreiras e os facilitadores à prática do Acompanhamento Farmacoterapêutico (AFT) nos serviços farmacêuticos hospitalares portugueses. Método: Estudo qualitativo mediante realização de entrevistas semi-estruturadas a farmacêuticos hospitalares com e sem experiência no AFT e análise de conteúdo, retroactiva e temática. Resultados: Estrutura dos serviços farmacêuticos: barreiras (1) falta de tempo, organização das actividades orientadas para a logística, instabilidade dos recursos humanos, barreiras físicas à comunicação, relações em divergência; facilitadores (2) reestruturação, trabalho em equipa. Farmacêutico: (1) resistência à mudança, qualificação inadequada; (2) atitude positiva, legitimação, formação. Meio externo: (1) falta de apoio institucional, relacionamento com o doente, o médico e farmacêutico comunitário, ensino inadequado; (2) apoio institucional, procura do doente, cooperação com o médico e o farmacêutico comunitário, ensino adequado. Tecnologia: (1) acesso aos dados clínicos e a informação, método inadequado; (2) acesso à informação, método adequado, documentação, informatização, marketing, boas práticas. Conclusão: As entrevistas semi-estruturadas fornecerem uma visão ampla, detalhada e pragmática dos potenciais determinantes de uma prática generalizada do AFT nos serviços farmacêuticos hospitalares portugueses. /ABSTRACT: Objectives: To identify and understand the barriers and facilitators for the practice of Medication Therapy Management (MTM) in portuguese’s hospital pharmacy. Method: Qualitative study trough semi-structured interviews with MTM experienced and inexperienced hospital pharmacists followed by retroactive content and thematic analysis. Results: Structure of hospital pharmacy: barriers (1) lack of time, activities focused on logistics, instability of human resources, physical barriers to communication, divergent relationships; facilitators (2) restructuring, teamwork. Pharmacist: (1) resistance to change, inadequate skills, (2) positive attitude, legitimating, formation. Environment: (1) lack of institutional support, relationship with patient, physician and community pharmacist, inadequate teaching, (2) institutional support, patient's demand, cooperation with physician and community pharmacist, appropriate teaching. Technology: (1) lack of access to clinical data and information, inadequate method, (2) access to information, appropriate method, documentation, computerization, marketing, good pharmacy practices. Conclusion: The semi-structured interviews provide a broad, comprehensive and pragmatic view of potential determinants for wide practice of MTM in Portuguese’s hospital pharmacy.

Customer Loyalty toward grocery retailing service: a multidimensional approach to costumer perceived value

Structured abstract Purpose: To deepen, in grocery retail context, the roles of consumer perceived value and consumer satisfaction, as antecedents’ dimensions of customer loyalty intentions. Design/Methodology/approach: Also employing a short version (12-items) of the original 19-item PERVAL scale of Sweeney & Soutar (2001), a structural equation modeling approach was applied to investigate statistical properties of the indirect influence on loyalty of a reflective second order customer perceived value model. The performance of three alternative estimation methods was compared through bootstrapping techniques. Findings: Results provided i) support for the use of the short form of the PERVAL scale in measuring consumer perceived value; ii) the influence of the four highly correlated independent latent predictors on satisfaction was well summarized by a higher-order reflective specification of consumer perceived value; iii) emotional and functional dimensions were determinants for the relationship with the retailer; iv) parameter’s bias with the three methods of estimation was only significant for bootstrap small sample sizes. Research limitations:/implications: Future research is needed to explore the use of the short form of the PERVAL scale in more homogeneous groups of consumers. Originality/value: Firstly, to indirectly explain customer loyalty mediated by customer satisfaction it was adopted a recent short form of PERVAL scale and a second order reflective conceptualization of value. Secondly, three alternative estimation methods were used and compared through bootstrapping and simulation procedures.

Mars delivery service - development of the electro-mechanical systems of the Sample Fetch Rover for the Mars Sample Return Campaign

This thesis describes the development of the Sample Fetch Rover (SFR), studied for Mars Sample Return (MSR), an international campaign carried out in cooperation between the National Aeronautics and Space Administration (NASA) and the European Space Agency (ESA). The focus of this document is the design of the electro-mechanical systems of the rover. After placing this work into the general context of robotic planetary exploration and summarising the state of the art for what concerns Mars rovers, the architecture of the Mars Sample Return Campaign is presented. A complete overview of the current SFR architecture is provided, touching upon all the main subsystems of the spacecraft. For each area, it is discussed what are the design drivers, the chosen solutions and whether they use heritage technology (in particular from the ExoMars Rover) or new developments. This research focuses on two topics of particular interest, due to their relevance for the mission and the novelty of their design: locomotion and sample acquisition, which are discussed in depth. The early SFR locomotion concepts are summarised, covering the initial trade-offs and discarded designs for higher traverse performance. Once a consolidated architecture was reached, the locomotion subsystem was developed further, defining the details of the suspension, actuators, deployment mechanisms and wheels. This technology is presented here in detail, including some key analysis and test results that support the design and demonstrate how it responds to the mission requirements. Another major electro-mechanical system developed as part of this work is the one dedicated to sample tube acquisition. The concept of operations of this machinery was defined to be robust against the unknown conditions that characterise the mission. The design process led to a highly automated robotic system which is described here in its main components: vision system, robotic arm and tube storage.

The transformative potential of community engagement in higher education: an analysis of service-learning effects on students, communities, and institutions.

Service-learning in higher education is gaining attention as a reliable tool to support students’ learning and fulfil the mission of higher education institutions (HEIs). This dissertation addresses existing gaps in the literature by examining the effects and perspectives of service-learning in HEIs through three studies. The first study compares the effects of a voluntary semester-long service-learning course with traditional courses. A survey completed by 110 students before and after the lectures found no significant group differences in the psychosocial variables under inspection. Nevertheless, service-learning students showed higher scores concerning the quality of participation. Factors such as students’ perception of competence, duration of service-learning, and self-reported measures may have influenced the results. The second study explores the under-researched perspective of community partners in higher education and European settings. Twelve semi-structured interviews were conducted with community partners from various community organisations across Europe. The results highlight positive effects on community members and organisations, intrinsic motivations, organisational empowerment, different forms of reciprocity, the co-educational role of community partners, and the significant role of a sense of community and belonging. The third study focuses on faculty perspectives on service-learning in the European context. Twenty-two semi-structured interviews were conducted in 14 European countries. The findings confirm the transformative impact of service-learning on the community, students, teachers, and HEIs, emphasising the importance of motivation and institutionalisation processes in sustaining engaged scholarship. The study also identifies the relevance of the community experience, sense of community, and community responsibility with the service-learning experience; relatedness is proposed as the fifth pillar of service-learning. Overall, this dissertation provides new insights into the effects and perspectives of service-learning in higher education. It integrates the 4Rs model with the addition of relatedness, guiding the theoretical and practical implications of the findings. The dissertation also suggests limitations and areas for further research.

An architecture for network acceleration as a service in the cloud continuum

The pervasive availability of connected devices in any industrial and societal sector is pushing for an evolution of the well-established cloud computing model. The emerging paradigm of the cloud continuum embraces this decentralization trend and envisions virtualized computing resources physically located between traditional datacenters and data sources. By totally or partially executing closer to the network edge, applications can have quicker reactions to events, thus enabling advanced forms of automation and intelligence. However, these applications also induce new data-intensive workloads with low-latency constraints that require the adoption of specialized resources, such as high-performance communication options (e.g., RDMA, DPDK, XDP, etc.). Unfortunately, cloud providers still struggle to integrate these options into their infrastructures. That risks undermining the principle of generality that underlies the cloud computing scale economy by forcing developers to tailor their code to low-level APIs, non-standard programming models, and static execution environments. This thesis proposes a novel system architecture to empower cloud platforms across the whole cloud continuum with Network Acceleration as a Service (NAaaS). To provide commodity yet efficient access to acceleration, this architecture defines a layer of agnostic high-performance I/O APIs, exposed to applications and clearly separated from the heterogeneous protocols, interfaces, and hardware devices that implement it. A novel system component embodies this decoupling by offering a set of agnostic OS features to applications: memory management for zero-copy transfers, asynchronous I/O processing, and efficient packet scheduling. This thesis also explores the design space of the possible implementations of this architecture by proposing two reference middleware systems and by adopting them to support interactive use cases in the cloud continuum: a serverless platform and an Industry 4.0 scenario. A detailed discussion and a thorough performance evaluation demonstrate that the proposed architecture is suitable to enable the easy-to-use, flexible integration of modern network acceleration into next-generation cloud platforms.

Can We Predict The Clinical Outcomes Of Genitourinary Trauma Patients And Offer Them An Evidence-based Support? The Case For Telemedicine Network.

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[principles Of Universality, Comprehensiveness And Equity In A Hearing Health Care Service].

This article analyzed whether the practices of hearing health care were consistent with the principles of universality, comprehensiveness and equity from the standpoint of professionals. It involved qualitative research conducted at a Medium Complexity Hearing Health Care Center. A social worker, three speech therapists, a physician and a psychologist constituted the study subjects. Interviews were conducted as well as observation registered in a field diary. The thematic analysis technique was used in the analysis of the material. The analysis of interviews resulted in the construction of the following themes: Universality and access to hearing health, Comprehensive Hearing Health Care and Hearing Health and Equity. The study identified issues that interfere with the quality of service and run counter to the principles of Brazilian Unified Health System. The conclusion reached was that a relatively simple investment in training and professional qualification can bring about significant changes in order to promote a more universal, comprehensive and equitable health service.

Identification Of Corynebacterium Spp. Isolated From Bovine Intramammary Infections By Matrix-assisted Laser Desorption Ionization-time Of Flight Mass Spectrometry.

Corynebacterium species (spp.) are among the most frequently isolated pathogens associated with subclinical mastitis in dairy cows. However, simple, fast, and reliable methods for the identification of species of the genus Corynebacterium are not currently available. This study aimed to evaluate the usefulness of matrix-assisted laser desorption ionization/mass spectrometry (MALDI-TOF MS) for identifying Corynebacterium spp. isolated from the mammary glands of dairy cows. Corynebacterium spp. were isolated from milk samples via microbiological culture (n=180) and were analyzed by MALDI-TOF MS and 16S rRNA gene sequencing. Using MALDI-TOF MS methodology, 161 Corynebacterium spp. isolates (89.4%) were correctly identified at the species level, whereas 12 isolates (6.7%) were identified at the genus level. Most isolates that were identified at the species level with 16 S rRNA gene sequencing were identified as Corynebacterium bovis (n=156; 86.7%) were also identified as C. bovis with MALDI-TOF MS. Five Corynebacterium spp. isolates (2.8%) were not correctly identified at the species level with MALDI-TOF MS and 2 isolates (1.1%) were considered unidentified because despite having MALDI-TOF MS scores >2, only the genus level was correctly identified. Therefore, MALDI-TOF MS could serve as an alternative method for species-level diagnoses of bovine intramammary infections caused by Corynebacterium spp.

Impact Of Pharmacist Interventions On Drug-related Problems And Laboratory Markers In Outpatients With Human Immunodeficiency Virus Infection.

Substantial complexity has been introduced into treatment regimens for patients with human immunodeficiency virus (HIV) infection. Many drug-related problems (DRPs) are detected in these patients, such as low adherence, therapeutic inefficacy, and safety issues. We evaluated the impact of pharmacist interventions on CD4+ T-lymphocyte count, HIV viral load, and DRPs in patients with HIV infection. In this 18-month prospective controlled study, 90 outpatients were selected by convenience sampling from the Hospital Dia-University of Campinas Teaching Hospital (Brazil). Forty-five patients comprised the pharmacist intervention group and 45 the control group; all patients had HIV infection with or without acquired immunodeficiency syndrome. Pharmaceutical appointments were conducted based on the Pharmacotherapy Workup method, although DRPs and pharmacist intervention classifications were modified for applicability to institutional service limitations and research requirements. Pharmacist interventions were performed immediately after detection of DRPs. The main outcome measures were DRPs, CD4+ T-lymphocyte count, and HIV viral load. After pharmacist intervention, DRPs decreased from 5.2 (95% confidence interval [CI] =4.1-6.2) to 4.2 (95% CI =3.3-5.1) per patient (P=0.043). A total of 122 pharmacist interventions were proposed, with an average of 2.7 interventions per patient. All the pharmacist interventions were accepted by physicians, and among patients, the interventions were well accepted during the appointments, but compliance with the interventions was not measured. A statistically significant increase in CD4+ T-lymphocyte count in the intervention group was found (260.7 cells/mm(3) [95% CI =175.8-345.6] to 312.0 cells/mm(3) [95% CI =23.5-40.6], P=0.015), which was not observed in the control group. There was no statistical difference between the groups regarding HIV viral load. This study suggests that pharmacist interventions in patients with HIV infection can cause an increase in CD4+ T-lymphocyte counts and a decrease in DRPs, demonstrating the importance of an optimal pharmaceutical care plan.

Remediation Of 17-α-ethinylestradiol Aqueous Solution By Photocatalysis And Electrochemically-assisted Photocatalysis Using Tio2 And Tio2/wo3 Electrodes Irradiated By A Solar Simulator.

TiO2 and TiO2/WO3 electrodes, irradiated by a solar simulator in configurations for heterogeneous photocatalysis (HP) and electrochemically-assisted HP (EHP), were used to remediate aqueous solutions containing 10 mg L(-1) (34 μmol L(-1)) of 17-α-ethinylestradiol (EE2), active component of most oral contraceptives. The photocatalysts consisted of 4.5 μm thick porous films of TiO2 and TiO2/WO3 (molar ratio W/Ti of 12%) deposited on transparent electrodes from aqueous suspensions of TiO2 particles and WO3 precursors, followed by thermal treatment at 450 (°)C. First, an energy diagram was organized with photoelectrochemical and UV-Vis absorption spectroscopy data and revealed that EE2 could be directly oxidized by the photogenerated holes at the semiconductor surfaces, considering the relative HOMO level for EE2 and the semiconductor valence band edges. Also, for the irradiated hybrid photocatalyst, electrons in TiO2 should be transferred to WO3 conduction band, while holes move toward TiO2 valence band, improving charge separation. The remediated EE2 solutions were analyzed by fluorescence, HPLC and total organic carbon measurements. As expected from the energy diagram, both photocatalysts promoted the EE2 oxidation in HP configuration; after 4 h, the EE2 concentration decayed to 6.2 mg L(-1) (35% of EE2 removal) with irradiated TiO2 while TiO2/WO3 electrode resulted in 45% EE2 removal. A higher performance was achieved in EHP systems, when a Pt wire was introduced as a counter-electrode and the photoelectrodes were biased at +0.7 V; then, the EE2 removal corresponded to 48 and 54% for the TiO2 and TiO2/WO3, respectively. The hybrid TiO2/WO3, when compared to TiO2 electrode, exhibited enhanced sunlight harvesting and improved separation of photogenerated charge carriers, resulting in higher performance for removing this contaminant of emerging concern from aqueous solution.

[evaluation Of Data On Live Birth Certificates From The Information System On Live Births (sinasc) In Campinas, São Paulo, 2009].

To assess the completeness and reliability of the Information System on Live Births (Sinasc) data. A cross-sectional analysis of the reliability and completeness of Sinasc's data was performed using a sample of Live Birth Certificate (LBC) from 2009, related to births from Campinas, Southeast Brazil. For data analysis, hospitals were grouped according to category of service (Unified National Health System, private or both), 600 LBCs were randomly selected and the data were collected in LBC-copies through mothers and newborns' hospital records and by telephone interviews. The completeness of LBCs was evaluated, calculating the percentage of blank fields, and the LBCs agreement comparing the originals with the copies was evaluated by Kappa and intraclass correlation coefficients. The percentage of completeness of LBCs ranged from 99.8%-100%. For the most items, the agreement was excellent. However, the agreement was acceptable for marital status, maternal education and newborn infants' race/color, low for prenatal visits and presence of birth defects, and very low for the number of deceased children. The results showed that the municipality Sinasc is reliable for most of the studied variables. Investments in training of the professionals are suggested in an attempt to improve system capacity to support planning and implementation of health activities for the benefit of maternal and child population.

The Environment Of Professional Practice And Burnout In Nurses In Primary Healthcare.

to assess how nurses perceive autonomy, control over the environment, the professional relationship between nurses and physicians and the organizational support and correlate them with burnout, satisfaction at work, quality of work and the intention to quit work in primary healthcare. cross-sectional and correlation study, using a sample of 198 nurses. The tools used were the Nursing Work Index Revised, Maslach Burnout Inventory and a form to characterize the nurses. To analyze the data, descriptive statistics were applied and Spearman's correlation coefficient was used. the nurses assessed that the environment is partially favorable for: autonomy, professional relationship and organizational support and that the control over this environment is limited. Significant correlations were evidenced between the Nursing Work Index Revised, Maslach Burnout Inventory and the variables: satisfaction at work, quality of care and the intent to quit the job. the nurses' perceptions regarding the environment of practice are correlated with burnout, satisfaction at work, quality of care and the intent to quit the job. This study provides support for the restructuring of work processes in the primary health care environment and for communication among the health service management, human resources and occupational health areas.

Supercritical Carbon Dioxide Extraction Of Capsaicinoids From Malagueta Pepper (capsicum Frutescens L.) Assisted By Ultrasound.

Extracts from malagueta pepper (Capsicum frutescens L.) were obtained using supercritical fluid extraction (SFE) assisted by ultrasound, with carbon dioxide as solvent at 15MPa and 40°C. The SFE global yield increased up to 77% when ultrasound waves were applied, and the best condition of ultrasound-assisted extraction was ultrasound power of 360W applied during 60min. Four capsaicinoids were identified in the extracts and quantified by high performance liquid chromatography. The use of ultrasonic waves did not influence significantly the capsaicinoid profiles and the phenolic content of the extracts. However, ultrasound has enhanced the SFE rate. A model based on the broken and intact cell concept was adequate to represent the extraction kinetics and estimate the mass transfer coefficients, which were increased with ultrasound. Images obtained by field emission scanning electron microscopy showed that the action of ultrasonic waves did not cause cracks on the cell wall surface. On the other hand, ultrasound promoted disturbances in the vegetable matrix, leading to the release of extractable material on the solid surface. The effects of ultrasound were more significant on SFE from larger solid particles.

A Metabolomic Protocol For Plant Systematics By Matrix-assisted Laser-desorption/ionization Time-of Flight Mass Spectrometry.

Matrix-assisted laser desorption/ionization time-of flight mass spectrometry (MALDI-TOF MS) has been widely used for the identification and classification of microorganisms based on their proteomic fingerprints. However, the use of MALDI-TOF MS in plant research has been very limited. In the present study, a first protocol is proposed for metabolic fingerprinting by MALDI-TOF MS using three different MALDI matrices with subsequent multivariate data analysis by in-house algorithms implemented in the R environment for the taxonomic classification of plants from different genera, families and orders. By merging the data acquired with different matrices, different ionization modes and using careful algorithms and parameter selection, we demonstrate that a close taxonomic classification can be achieved based on plant metabolic fingerprints, with 92% similarity to the taxonomic classifications found in literature. The present work therefore highlights the great potential of applying MALDI-TOF MS for the taxonomic classification of plants and, furthermore, provides a preliminary foundation for future research.

Matrix Support And Institutional Support: Analyzing Their Construction.

This is an analysis of the theoretical and practical construction of the methodology of Matrix Support by means of studies on Paideia Support (Institutional and Matrix Support), which is an inter-professional work of joint care in recent literature and official documents of the Unified Health System (SUS). An attempt was made to describe methodological concepts and strategies. A comparative analysis of Institutional Support and Matrix Support was also conducted using the epistemological framework of Field and Core Knowledge and Practices.