O erro na fase pré-analítica : amostras não conformes versus procedimentos

RESUMO: As Análises Clínicas são um precioso elemento entre os meios complementares de diagnóstico e terapêutica permitindo uma enorme panóplia de informações sobre o estado de saúde de determinado utente. O objetivo do laboratório é fornecer informação analítica sobre as amostras biológicas, sendo esta caracterizada pela sua fiabilidade, relevância e facultada em tempo útil. Assim, tratando-se de saúde, e mediante o propósito do laboratório, é notória a sua importância, bem como, a dos fatores associados para o cumprimento do mesmo. O bom desenrolar do ciclo laboratorial, compreendido pelas fases pré-analítica, analítica e pós-analítica é crucial para que o objetivo do laboratório seja cumprido com rigor e rapidez. O presente trabalho “O Erro na Fase Pré-Analítica: Amostras Não Conformes versus Procedimentos”, enquadrado no mestrado de Qualidade e Organização no Laboratório de Análises Clínicas, pretendeu enfatizar a importância da fase pré- analítica, sendo ela apontada como a primordial em erros que acabam por atrasar a saída de resultados ou por permitir que os mesmos não sejam fidedignos como se deseja, podendo acarretar falsos diagnósticos e decisões clínicas erradas. Esta fase, iniciada no pedido médico e finalizada com a chegada das amostras biológicas ao laboratório está entregue a uma diversidade de procedimentos que acarretam, por si só, uma grande diversidade de intervenientes, para além de uma variabilidade de factores que influenciam a amostra e seus resultados. Estes fatores, que podem alterar de algum modo a “veracidade” dos resultados analíticos, devem ser identificados e tidos em consideração para que estejamos convitos que os resultados auxiliam diagnósticos precisos e uma avaliação correta do estado do utente. As colheitas que por quaisquer divergências não originam amostras que cumpram o objectivo da sua recolha, não estando por isso em conformidade com o pretendido, constituem uma importante fonte de erro para esta fase pré-analítica. Neste estudo foram consultados os dados relativos a amostras de sangue e urina não conformes detetadas no laboratório, em estudo, durante o 1º trimestre de 2012, para permitir conhecer o tipo de falhas que acontecem e a sua frequência. Aos Técnicos de Análises Clínicas, colaboradores do laboratório, foi-lhes pedido que respondessem a um questionário sobre os seus procedimentos quotidianos e constituíssem, assim, a população desta 2ª parte do projeto. Preenchido e devolvido de forma anónima, este questionário pretendeu conhecer os procedimentos na tarefa de executar colheitas e, hipoteticamente, confrontá-los com as amostras não conformes verificadas. No 1ºsemestre de 2012 e num total de 25319 utentes registaram-se 146 colheitas que necessitaram de repetição por se verificarem não conformes. A “amostra não colhida” foi a não conformidade mais frequente (50%) versus a “má identificação” que registou somente 1 acontecimento. Houve ainda não conformidades que não se registaram como “preparação inadequada” e “amostra mal acondicionada”. Os técnicos revelaram-se profissionais competentes, conhecedores das tarefas a desempenhar e preocupados em executá-las com qualidade. Eliminar o erro não estará, seguramente, ao nosso alcance porém admitir a sua presença, detetá-lo e avaliar a sua frequência fará com que possamos diminuir a sua existência e melhorar a qualidade na fase pré-analítica, atribuindo-lhe a relevância que desempenha no processo laboratorial.-----------ABSTRACT:Clinical analyses are a precious element among diagnostic and therapeutic tests as they allow an enormous variety of information on the state of health of a user. The aim of the laboratory is to supply reliable, relevant and timely analytical information on biological samples. In health-related matters, in accordance with the objective of the laboratory, their importance is vital, as is the assurance that all the tools are in place for the fulfillment of its purpose. A good laboratory cycle, which includes the pre-analytical, analytical and post-analytical phases, is crucial in fulfilling the laboratory’s mission rapidly and efficiently. The present work - "Error in the pre-analytical phase: non-compliant samples versus procedures”, as part of the Master’s in Quality and Organization in the Clinical Analyses Laboratory, wishes to emphasize the importance of the pre-analytical phase, as the phase containing most errors which eventually lead to delays in the issue of results, or the one which enables those results not to be as reliable as desired, which can lead to false diagnosis and wrong clinical decisions. This phase, which starts with the medical request and ends with the arrival of the biological samples to the laboratory, entails a variety of procedures, which require the intervention of different players, not to mention a great number of factors, which influence the sample and the results. These factors, capable of somehow altering the “truth” of the analytical results, must be identified and taken into consideration so that we may ensure that the results help to make precise diagnoses and a correct evaluation of the user’s condition. Those collections which, due to any type of differences, do not originate samples capable of fulfilling their purpose, and are therefore not compliant with the objective, constitute an important source of error in this pre-analytical phase. In the present study, we consulted data from non-compliant blood and urine samples, detected at the laboratory during the 1st quarter of 2012, to find out the type of faults that happen and their frequency. The clinical analysis technicians working at the laboratory were asked to fill out a questionnaire regarding their daily procedures, forming in this way the population for this second part of the project. Completed and returned anonymously, this questionnaire intended to investigate the procedures for collections and, hypothetically, confront them with the verified non-compliant samples. In the first semester of 2012, and out of a total of 25319 users, 146 collections had to be repeated due to non-compliance. The “uncollected sample” was the most frequent non-compliance (>50%) versus “incorrect identification” which had only one occurrence. There were also unregistered non-compliance issues such as “inadequate preparation” and “inappropriately packaged sample”. The technicians proved to be competent professionals, with knowledge of the tasks they have to perform and eager to carry them out efficiently. We will certainly not be able to eliminate error, but recognizing its presence, detecting it and evaluating its frequency will help to decrease its occurrence and improve quality in the pre-analytical phase, giving it the relevance it has within the laboratory process.

A "Portrait" of Book XII of the Æneid: the Mosaic of the «House of the Medusa» (Alter do Chão, Portugal)

This paper addresses the study of a mosaic discovered in 2007 at the archaeological site of Alter do Chão, Portugal, whose central panel represents the penultimate scene narrated in the last Book of the Æneid – a Roman epic composed by the poet Publius Vergilius Maro (70 BC – AD 19), at the request of Gaius Julius Cæsar Octavianus Augustus (63 BC – AD 14): it shows the very moment when Turnus, the Latin king of the Rutuli, kneels before Æneas, considered the precursor to the foundation of Rome (Virgil, Æneid, XII, 926-950).

Co-criação de valor do consumidor : impacto na fidelização do paciente ao médico

RESUMO - Confrontados por uma procura mais ativa e exigente e pressionados por uma maior restrição orçamental, os prestadores de saúde têm vindo a reconhecer o Marketing de Fidelização como uma solução sustentável para o seu sucesso financeiro. Assim, a autora explora como se desenvolve a cocriação de valor do consumidor no setor de saúde, nomeadamente, as interações, os atores e as atividades envolvidas na gestão e tratamento da doença. O projeto de investigação foca-se particularmente na cocriação de valor entre o médico regular e o paciente. Foi realizada uma pesquisa exploratória de natureza qualitativa. Os dados recolhidos na APDP, a uma amostra de 16 pacientes diabéticos através da técnica de entrevistas aprofundadas, revelaram que os estilos práticos de criação de valor do consumidor (CVCPS) desenvolvido por McColl-Kennedy et al. (2012) adequam-se às características desta doença. Os resultados do estudo sustentam que os pacientes com estilos práticos de cocriação de valor do consumidor “Parceria” e “Gestor de equipa” tendem a estar associados a um nível de fidelização elevado, pelo que se sugere que estes estilos sejam encorajados pelos prestadores. Em contraste, o Estilo de cocriação “Colaboração Passiva” está potencialmente associado a níveis de fidelização reduzidos, o que também sugere que a participação do paciente no seu relacionamento com o médico possa ser um fator potenciador da sua fidelização. O presente projeto de Investigação pretende ser um contributo teórico para investigação futura na área da cocriação e fidelização, com uma aplicação empírica que contribui para uma maior extensividade dos benefícios da cocriação de valor do consumidor para a Gestão em Saúde.

Seroepidemiological study of human cysticercosis with blood samples collected on filter paper, in Lages, State of Santa Catarina, Brazil, 2004-2005

INTRODUCTION: Human serofrequency of antibodies against Taenia solium antigens was determined and risk factors for cysticercosis transmission were identified. METHODS: Individuals (n=878) from periurban and rural locations of Lages, SC, were interviewed to gather demographic, sanitary and health information. Interviews and blood sample collections by finger prick on Whatman filter paper were performed from August 2004 to May 2005. Observation determined that 850 samples were suitable for analysis and were tested by ELISA using vesicular fluid of Taenia crassiceps heterologous antigen. To ensure the reliability of the results, 77 samples of the dried blood were matched with sera. The reactive samples were submitted to a serum confirmatory immunoblot (IB) test using purified Taenia crassiceps glycoproteins. RESULTS: The ELISA results for the dried blood and serum samples were statistically consistent. ELISA was positive in 186 (21.9%) out of 850 individuals. A group of 213 individuals were asked to collect vein blood for IB (186 with positive result in ELISA and 27 with inappropriate whole blood samples) and 130 attended the request. The IB was positive in 29 (3.4%) out of 850 individuals. A significant correlation (p = 0.0364) was determined among individuals who tested positive in the IB assay who practiced both pig rearing and kitchen gardening. CONCLUSIONS: ELISA with dried blood eluted from filter paper was suitable for cysticercosis population surveys. In Lages, human infection was associated with pig rearing and kitchen gardening. The prevalence index was compatible with other Latin American endemic areas.

Wealth Management in Africa: The Cape Verde Opportunity

This work project consists of a comprehensive study of the possibility of opening a Wealth Management (WM) firm located in Cape Verde (CV), and was made at the request of NovoBanco’s Research Sectorial team. WM is a growing industry that consists in the set of financial services provided to wealthy clients. After taking into account the expected industry growth of the Sub-Saharan region, the preferences of the African wealthy, the current industry structure, and the advantages and disadvantages of locating a WM business in CV, it is concluded that a business opportunity exists. The reasons for thus, along with relevant recommendations, including which services a new business should offer and whom to target specifically, are presented in the final section.

Serological diagnosis of Chagas disease in HIV-infected patients

INTRODUCTION: This study assessed the rate of request for the serological diagnosis of Chagas disease among human immunodeficiency virus (HIV)-infected patients treated at the Specialized Care Service of Pelotas, Rio Grande do Sul, Brazil. METHODS: This cross-sectional study used secondary data obtained from the medical records of 252 patients aged between 18 and 75 years. RESULTS: The serological diagnosis of Chagas disease was requested only in 3.2% of cases. CONCLUSIONS: The results demonstrate poor adherence to protocols on the part of healthcare professionals, indicating the need to reevaluate the procedures applied to HIV-infected patients from endemic regions for both diseases.

O âmbito de aplicação material da legislação de proteção de dados pessoais e o tratamento de imagem por pessoa singular

Images have gained a never before seen importance. Technological changes have given the Information Society extraordinary means to capture, treat and transmit images, wheter your own or those of others, with or without a commercial purpose, with no boundaries of time or country, without “any kind of eraser”. From the several different ways natural persons may engage in image processing with no commercial purpose, the cases of sharing pictures through social networks and video surveillance assume particular relevance. Consequently there are growing legitimate concerns with the protection of one's image, since its processing may sometimes generate situations of privacy invasion or put at risk other fundamental rights. With this in mind, the present thesis arises from the question: what are the existent legal instruments in Portuguese Law that enable citizens to protect themselves from the abusive usage of their own pictures, whether because that image have been captured by a smartphone or some video surveillance camera, whether because it was massively shared through a blog or some social network? There is no question the one's right to not having his or her image used in an abusive way is protected by the Portuguese constitution, through the article 26th CRP, as well as personally right, under the article 79th of the Civil Code, and finally through criminal law, articles 192nd and 193rd of the Criminal Code. The question arises in the personal data protection context, considering that one's picture, given certain conditions, is personal data. Both the Directive 95/46/CE dated from 1995 as well as the LPD from 1998 are applicable to the processing of personal data, but both exclude situations of natural persons doing so in the pursuit of activities strictly personal or family-related. These laws demand complex procedures to natural persons, such as the preemptive formal authorisation request to the Data Protection National Commission. Failing to do so a natural person may result in the application of fines as high as €2.500,00 or even criminal charges. Consequently, the present thesis aims to study if the image processing with no commercial purposes by a natural person in the context of social networks or through video surveillance belongs to the domain of the existent personal data protection law. To that effect, it was made general considerations regarding the concept of video surveillance, what is its regimen, in a way that it may be distinguishable from Steve Mann's definition of sousveillance, and what are the associated obligations in order to better understand the concept's essence. The application of the existent laws on personal data protection to images processing by natural persons has been analysed taking into account the Directive 95/46/CE, the LPD and the General Regulation. From this analysis it is concluded that the regimen from 1995 to 1998 is out of touch with reality creating an absence of legal shielding in the personal data protection law, a flaw that doesn't exist because compensated by the right to image as a right to personality, that anyway reveals the inability of the Portuguese legislator to face the new technological challenges. It is urgent to legislate. A contrary interpretation will evidence the unconstitutionality of several rules on the LPD due to the obligations natural persons are bound to that violate the right to the freedom of speech and information, which would be inadequate and disproportionate. Considering the recently approved General Regulation and in the case it becomes the final version, the use for natural person of video surveillance of private spaces, Google Glass (in public and private places) and other similar gadgets used to recreational purposes, as well as social networks are subject to its regulation only if the images are shared without limits or existing commercial purposes. Video surveillance of public spaces in all situations is subject to General Regulation provisions.

Relatório de estágio curricular no Centro de Arbitragem Comercial

The main purpose of this report is to present the work developed during the curricular internship on the Commercial Arbitration Centre of the Portuguese Chamber of Commerce and Industry. It is structured in two parts. The first, in which i´ll present the CAC, its organic structure and its activities. In this part I will also show the work I´ve done during the internship, as well as i´m going to identified, and comment, the tasks performed. The second part presents a study on arbitration awards that aimed to determine the amount “split the baby awards”, that is to say those that condemn in (approximately) half of the request. In addition to these data, I collected from sentences other, such as the duration of the cases, the number of foreign persons in each process, the number of foreign arbitrators, the language of proceedings etc. What is expected with this paperwork is to be able to clarify, and make known, some aspects on Arbitration in Portugal, thus contributing to the strengthening of the role of the Arbitration and Arbitral Justice.

Reflexão crítica sobre a redução das pensões no âmbito da convergência dos regimes da Caixa Geral de Aposentações e da Segurança Social

Dissertação de mestrado em Direito Tributário e Fiscal

Processo SAAL: o contributo para a concepção arquitectónica da habitação social

Dissertação de mestrado integrado em Arquitectura

A Reorganização Administrativa do Território das Freguesias 2013 enquanto determinante de voto: estudo caso do Concelho de Braga e Guimarães

Dissertação de mestrado em Administração Pública

Formação e avaliação de desempenho: contributos para o desenvolvimento profissional

Tese de Doutoramento em Ciências da Educação (Especialidade em Desenvolvimento Curricular)

Estudo sobre os determinantes dos projetos financiados por crowdfunding: o caso do PPL Crowdfunding

Dissertação de mestrado em Economia Social

Perspetivas públicas em relação aos biobancos médicos e para investigação científica em Portugal

Dissertação de mestrado em Crime, Diferença e Desigualdade

Mobilidade geográfica dos trabalhadores e implicações processuais

Dissertação de mestrado em Direito Judiciário