817 resultados para National Prize of Quality


Relevância:

100.00% 100.00%

Publicador:

Resumo:

The theme Corporate Social Responsibility is relatively recent both in the academic field and in the business practice. Because of the lack of socialization of experiences and precision of concepts, there are gaps regarding the understanding of the subject and, also, how to conduct operations. This study just seeks to investigate such matter, focusing applications of social responsibility in business. It takes, as empirical field, winners of the PSQT - SESI Prize of Quality at Work in Rio Grande do Norte (2002-2007) in order to systematize the various approaches on the issue, aiming to reveal subjective visions and perspectives of the theme. It is characterized as a qualitative study, carried out by structured interview. The universe was composed by 15 companies. It was used analysis of content categorical as an axis for the interpretation of the information. Three approaches guided the analysis: Business Ethics, (normative); Business & Society (contractual); Social Issues Management (strategic). The findings are related in three ways: 1) reasons for the CSR practice; 2) the results obtained; 3) the means of CSR. It was found that the award participation occurs, mostly, linked to SESI invitations, so, as an articulated movement of industrial corporations in Brazil it occurs, also, because of the organizational commitment with the society and the possibility of internal and social growths and because of the importance attributed to the report as an instrument of consultancy. There are no indicators to check impacts of organizational interventions, in spite of the existence of planning for the actions. Social responsibility appears as a tool to reinforce the organizational image and to increase satisfaction of the employees. There is a tendency of large and medium firms to a contractual commitment while the small and the micros firms are on strategic or normative level. The analysis of the perspectives of social responsibility future revealed trends towards for strategic approach

Relevância:

100.00% 100.00%

Publicador:

Resumo:

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Relevância:

100.00% 100.00%

Publicador:

Resumo:

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Relevância:

100.00% 100.00%

Publicador:

Resumo:

La presente tesis para optar al grado de Doctor en la Escuela Técnica Superior de Arquitectura de la Universidad Politécnica de Madrid, aborda la obra del arquitecto de origen español Juan Martínez Gutiérrez, reconocido por la crítica especializada como uno de los precursores de la arquitectura moderna en Chile. A pesar de la relevancia de su obra, en la actualidad se carece de un estudio sistematizado y preciso que, de manera global, expongan los factores de modernidad de sus principales edificios, aun cuando han aparecido en los últimos años dos publicaciones referentes al arquitecto y parcialmente a su obra. Formado tanto en arquitectura como en pintura, la labor profesional de Juan Martínez Gutiérrez se inscribió en un contexto de modernización de la sociedad chilena entre la década del 20 y del 50, adjudicándose mediante concurso público, el diseño de cinco edificios institucionales y de carácter público, los que conforman en la actualidad bienes de carácter patrimonial estando dos de ellos declarados Monumento Histórico. Se desenvolvió también en el ámbito de la docencia siendo profesor de la Facultad de Arquitectura y Urbanismo de la Universidad de Chile por más de 35 años y Decano de la misma institución. Participó asimismo de la vida gremial de la profesión, recibiendo en el año 1969 el primer premio nacional de arquitectura. Sus edificios públicos, se han mantenido en uso siendo hitos urbanos y en el ámbito disciplinar reconocidas obras ejemplares. Sin embargo, al comenzar el siglo XXI, cuando la modernidad se nos presenta desde la historicidad, surge la pregunta por los valores que sustenta la arquitectura de Juan Martínez, en relación a su tiempo y a la actualidad. En este ámbito reflexivo se plantea la puesta en tesis de la presente investigación, donde las principales obras del arquitecto se analizan inquiriendo su condición de modernidad a la luz de un contexto local cuyas problemáticas sociales son aunadas por el proyecto desarrollista estatal de la primera mitad del siglo XX; interpelando algunos aspectos del estado técnico del país durante el periodo; las tendencias estéticas imperantes de la época y el entorno urbano en el que se emplazan. Al mismo tiempo, el desarrollo de la tesis examina un tópico referencial de la modernidad latinoamericana, que es el influjo europeo en el punto de inflexión que va desde el fin del modelo academicista y la incorporación de los preceptos de un funcionalismo y racionalismo arquitectónico, todo ello mediado por los condicionantes locales. ABSTRACT The following thesis, to achieve the Doctor´s degree at the Superior Technical School of Architecture of the Polytechnic University of Madrid aboard the work of the chilean architect of spanish origin Juan Martinez Gutierrez, recognized by specialized critic as one of the forefathers of modern architecture in Chile. Although the relevance of his work, currently there is no systematic and precise study of it. A study that in a global view exposes the factors of modernity in his foremost buildings. The absence of such study is, despite the appearance in the last two years of two publications about the architect and –partially- his work. Formed as much in architecture as in painting, the professional labor of Juan Martinez Gutierrez was inscribed in the context of Chilean society modernization, between the decades of the 20´s and 30´s. Awarding himself, by means of architectural contests, the design of institutional buildings of public use, witch conform current cultural goods, two of them having been declared National Monuments; a category of cultural heritage officially protected by the state. He also developed an important academic work, being for more than 35 years, professor at the Faculty of Architecture and Urbanism at the University of Chile and in his time, Faculty Dean. He also participated, actively, in guild life, being awarded in 1969 the first ever, National Prize of Architecture. His public buildings, still in use, are urban landmarks and exemplar works in a disciplinary dimension. Never the less, at the begins of the XXI century, when the modern movement is presented to us from an historical viewpoint, even from historicity, questions surge about the values that sustain Juan Martinez´s architecture in relation to his time and ours. It is in this reflexive field, that is planted the thesis of the present research, where the principal works of the architect are analyzed inquiring their modern condition, at the light of a local context who´s social problems join the chilean social development state the “Estado Desarrolista” of the first half of the XX century, a situation that interpellants several dimensions: the technical status of the country during the period, the aesthetic tendencies prevailing, and the urban context were they place themselves. At the same time, in its development, the thesis examines a referential topic, that is the Latin American modern movement, or the European influx in that inflexion point that goes from the end of academicism Beaux – Art model and the incorporation of functional and rationalist precepts, all mediated by local conditions.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

The theme Corporate Social Responsibility is relatively recent both in the academic field and in the business practice. Because of the lack of socialization of experiences and precision of concepts, there are gaps regarding the understanding of the subject and, also, how to conduct operations. This study just seeks to investigate such matter, focusing applications of social responsibility in business. It takes, as empirical field, winners of the PSQT - SESI Prize of Quality at Work in Rio Grande do Norte (2002-2007) in order to systematize the various approaches on the issue, aiming to reveal subjective visions and perspectives of the theme. It is characterized as a qualitative study, carried out by structured interview. The universe was composed by 15 companies. It was used analysis of content categorical as an axis for the interpretation of the information. Three approaches guided the analysis: Business Ethics, (normative); Business & Society (contractual); Social Issues Management (strategic). The findings are related in three ways: 1) reasons for the CSR practice; 2) the results obtained; 3) the means of CSR. It was found that the award participation occurs, mostly, linked to SESI invitations, so, as an articulated movement of industrial corporations in Brazil it occurs, also, because of the organizational commitment with the society and the possibility of internal and social growths and because of the importance attributed to the report as an instrument of consultancy. There are no indicators to check impacts of organizational interventions, in spite of the existence of planning for the actions. Social responsibility appears as a tool to reinforce the organizational image and to increase satisfaction of the employees. There is a tendency of large and medium firms to a contractual commitment while the small and the micros firms are on strategic or normative level. The analysis of the perspectives of social responsibility future revealed trends towards for strategic approach

Relevância:

100.00% 100.00%

Publicador:

Resumo:

The theme Corporate Social Responsibility is relatively recent both in the academic field and in the business practice. Because of the lack of socialization of experiences and precision of concepts, there are gaps regarding the understanding of the subject and, also, how to conduct operations. This study just seeks to investigate such matter, focusing applications of social responsibility in business. It takes, as empirical field, winners of the PSQT - SESI Prize of Quality at Work in Rio Grande do Norte (2002-2007) in order to systematize the various approaches on the issue, aiming to reveal subjective visions and perspectives of the theme. It is characterized as a qualitative study, carried out by structured interview. The universe was composed by 15 companies. It was used analysis of content categorical as an axis for the interpretation of the information. Three approaches guided the analysis: Business Ethics, (normative); Business & Society (contractual); Social Issues Management (strategic). The findings are related in three ways: 1) reasons for the CSR practice; 2) the results obtained; 3) the means of CSR. It was found that the award participation occurs, mostly, linked to SESI invitations, so, as an articulated movement of industrial corporations in Brazil it occurs, also, because of the organizational commitment with the society and the possibility of internal and social growths and because of the importance attributed to the report as an instrument of consultancy. There are no indicators to check impacts of organizational interventions, in spite of the existence of planning for the actions. Social responsibility appears as a tool to reinforce the organizational image and to increase satisfaction of the employees. There is a tendency of large and medium firms to a contractual commitment while the small and the micros firms are on strategic or normative level. The analysis of the perspectives of social responsibility future revealed trends towards for strategic approach

Relevância:

100.00% 100.00%

Publicador:

Resumo:

BACKGROUND: With a pending need to identify potential means to improved quality of care, national quality registries (NQRs) are identified as a promising route. Yet, there is limited evidence with regards to what hinders and facilitates the NQR innovation, what signifies the contexts in which NQRs are applied and drive quality improvement. Supposedly, barriers and facilitators to NQR-driven quality improvement may be found in the healthcare context, in the politico-administrative context, as well as with an NQR itself. In this study, we investigated the potential variation with regards to if and how an NQR was applied by decision-makers and users in regions and clinical settings. The aim was to depict the interplay between the clinical and the politico-administrative tiers in the use of NQRs to develop quality of care, examining an established registry on stroke care as a case study. METHODS: We interviewed 44 individuals representing the clinical and the politico-administrative settings of 4 out of 21 regions strategically chosen for including stroke units representing a variety of outcomes in the NQR on stroke (Riksstroke) and a variety of settings. The transcribed interviews were analysed by applying The Consolidated Framework for Implementation Research (CFIR). RESULTS: In two regions, decision-makers and/or administrators had initiated healthcare process projects for stroke, engaging the health professionals in the local stroke units who contributed with, for example, local data from Riksstroke. The Riksstroke data was used for identifying improvement issues, for setting goals, and asserting that the stroke units achieved an equivalent standard of care and a certain level of quality of stroke care. Meanwhile, one region had more recently initiated such a project and the fourth region had no similar collaboration across tiers. Apart from these projects, there was limited joint communication across tiers and none that included all individuals and functions engaged in quality improvement with regards to stroke care. CONCLUSIONS: If NQRs are to provide for quality improvement and learning opportunities, advances must be made in the links between the structures and processes across all organisational tiers, including decision-makers, administrators and health professionals engaged in a particular healthcare process.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

Purpose. The measurement of quality of life has become an important topic in healthcare and in the allocation of limited healthcare resources. Improving the quality of life (QOL) in cancer patients is paramount. Cataract removal and lens implantation appears to improve patient well-being of cancer patients, though a formal measurement has never been published in the US literature. In this current study, National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), a validated vision quality of life metric, was used to study the change in vision-related quality of life in cancer patients who underwent cataract extraction with intraocular lens implantation. ^ Methods. Under an IRB approved protocol, cancer patients who underwent cataract surgery with intraocular lens implantation (by a single surgeon) from December 2008 to March 2011, and who had completed a pre- and postoperative NEI-VFQ-25 were retrospectively reviewed. Post-operative data was collected at their routine 4-6 week post-op visit. Patients' demographics, cancer history, their pre and postoperative ocular examinations, visual acuities, and NEI-VFQ-25 with twelve components were included in the evaluation. The responses were evaluated using the Student t test, Spearman correlation and Wilcoxon signed rank test. ^ Results. 63 cases of cataract surgery (from 54 patients) from the MD Anderson Cancer Center were included in the study. Cancer patients had a significant improvement in the visual acuity (P<0.0001) postoperatively, along with a significant increase in vision-related quality of life (P<0.0001). Patients also had a statistically significant improvement in ten of the twelve subcategories which are addressed in the NEI-VFQ-25. ^ Conclusions. In our study, cataract extraction and intraocular implantation showed a significant impact on the vision-related quality of life in cancer patients. Although this study includes a small sample size, it serves as a positive pilot study to evaluate and quantify the impact of a surgical intervention on QOL in cancer patients and may help to design a larger study to measure vision related QOL per dollar spent for health care cost in cancer patients.^

Relevância:

100.00% 100.00%

Publicador:

Resumo:

Purpose: This two-part research project was undertaken as part of the planning process by Queensland Health (QH), Cancer Screening Services Unit (CSSU), Queensland Bowel Cancer Screening Program (QBCSP), in partnership with the National Bowel Cancer Screening Program (NBCSP), to prepare for the implementation of the NBCSP in public sector colonoscopy services in QLD in late 2006. There was no prior information available on the quality of colonoscopy services in Queensland (QLD) and no prior studies that assessed the quality of colonoscopy training in Australia. Furthermore, the NBCSP was introduced without extra funding for colonoscopy service improvement or provision for increases in colonoscopic capacity resulting from the introduction of the NBCSP. The main purpose of the research was to record baseline data on colonoscopy referral and practice in QLD and current training in colonoscopy Australia-wide. It was undertaken from a quality improvement perspective. Implementation of the NBCSP requires that all aspects of the screening pathway, in particular colonoscopy services for the assessment of positive Faecal Occult Blood Tests (FOBTs), will be effective, efficient, equitable and evidence-based. This study examined two important aspects of the continuous quality improvement framework for the NBCSP as they relate to colonoscopy services: (1) evidence-based practice, and (2) quality of colonoscopy training. The Principal Investigator was employed as Senior Project Officer (Training) in the QBCSP during the conduct of this research project. Recommendations from this research have been used to inform the development and implementation of quality improvement initiatives for provision of colonoscopy in the NBCSP, its QLD counterpart the QBCSP and colonoscopy services in QLD, in general. Methods – Part 1 Chart audit of evidence-based practice: The research was undertaken in two parts from 2005-2007. The first part of this research comprised a retrospective chart audit of 1484 colonoscopy records (some 13% of all colonoscopies conducted in public sector facilities in the year 2005) in three QLD colonoscopy services. Whilst some 70% of colonoscopies are currently conducted in the private sector, only public sector colonoscopy facilities provided colonoscopies under the NBCSP. The aim of this study was to compare colonoscopy referral and practice with explicit criteria derived from the National Health & Medical Research Council (NHMRC) (1999) Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer, and describe the nature of variance with the guidelines. Symptomatic presentations were the most common indication for colonoscopy (60.9%). These comprised per rectal bleeding (31.0%), change of bowel habit (22.1%), abdominal pain (19.6%), iron deficiency anaemia (16.2%), inflammatory bowel disease (8.9%) and other symptoms (11.4%). Surveillance and follow-up colonoscopies accounted for approximately one-third of the remaining colonoscopy workload across sites. Gastroenterologists (GEs) performed relatively more colonoscopies per annum (59.9%) compared to general surgeons (GS) (24.1%), colorectal surgeons (CRS) (9.4%) and general physicians (GPs) (6.5%). Guideline compliance varied with the designation of the colonoscopist. Compliance was lower for CRS (62.9%) compared to GPs (76.0%), GEs (75.0%), GSs (70.9%, p<0.05). Compliance with guideline recommendations for colonoscopic surveillance for family history of colorectal cancer (23.9%), polyps (37.0%) and a past history of bowel cancer (42.7%), was by comparison significantly lower than for symptomatic presentations (94.4%), (p<0.001). Variation with guideline recommendations occurred more frequently for polyp surveillance (earlier than guidelines recommend, 47.9%) and follow-up for past history of bowel cancer (later than recommended, 61.7%, p<0.001). Bowel cancer cases detected at colonoscopy comprised 3.6% of all audited colonoscopies. Incomplete colonoscopies occurred in 4.3% of audited colonoscopies and were more common among women (76.6%). For all colonoscopies audited, the rate of incomplete colonoscopies for GEs was 1.6% (CI 0.9-2.6), GPs 2.0% (CI 0.6-7.2), GS 7.0% (CI 4.8-10.1) and CRS 16.4% (CI 11.2-23.5). 18.6% (n=55) of patients with a documented family history of bowel cancer had colonoscopy performed against guidelines recommendations (for general (category 1) population risk, for reasons of patient request or family history of polyps, rather than for high risk status for colorectal cancer). In general, family history was inadequately documented and subsequently applied to colonoscopy referral and practice. Methods - Part 2 Surveys of quality of colonoscopy training: The second part of the research consisted of Australia-wide anonymous, self-completed surveys of colonoscopy trainers and their trainees to ascertain their opinions on the current apprenticeship model of colonoscopy in Australia and to identify any training needs. Overall, 127 surveys were received from colonoscopy trainers (estimated response rate 30.2%). Approximately 50% of trainers agreed and 27% disagreed that current numbers of training places were adequate to maintain a skilled colonoscopy workforce in preparation for the NBCSP. Approximately 70% of trainers also supported UK-style colonoscopy training within dedicated accredited training centres using a variety of training approaches including simulation. A collaborative approach with the private sector was seen as beneficial by 65% of trainers. Non-gastroenterologists (non-GEs) were more likely than GEs to be of the opinion that simulators are beneficial for colonoscopy training (χ2-test = 5.55, P = 0.026). Approximately 60% of trainers considered that the current requirements for recognition of training in colonoscopy could be insufficient for trainees to gain competence and 80% of those indicated that ≥ 200 colonoscopies were needed. GEs (73.4%) were more likely than non-GEs (36.2%) to be of the opinion that the Conjoint Committee standard is insufficient to gain competence in colonoscopy (χ2-test = 16.97, P = 0.0001). The majority of trainers did not support training either nurses (73%) or GPs in colonoscopy (71%). Only 81 (estimated response rate 17.9%) surveys were received from GS trainees (72.1%), GE trainees (26.3%) and GP trainees (1.2%). The majority were males (75.9%), with a median age 32 years and who had trained in New South Wales (41.0%) or Victoria (30%). Overall, two-thirds (60.8%) of trainees indicated that they deemed the Conjoint Committee standard sufficient to gain competency in colonoscopy. Between specialties, 75.4% of GS trainees indicated that the Conjoint Committee standard for recognition of colonoscopy was sufficient to gain competence in colonoscopy compared to only 38.5% of GE trainees. Measures of competency assessed and recorded by trainees in logbooks centred mainly on caecal intubation (94.7-100%), complications (78.9-100%) and withdrawal time (51-76.2%). Trainees described limited access to colonoscopy training lists due to the time inefficiency of the apprenticeship model and perceived monopolisation of these by GEs and their trainees. Improvements to the current training model suggested by trainees included: more use of simulation, training tools, a United Kingdom (UK)-style training course, concentration on quality indicators, increased access to training lists, accreditation of trainers and interdisciplinary colonoscopy training. Implications for the NBCSP/QBCSP: The introduction of the NBCSP/QBCSP necessitates higher quality colonoscopy services if it is to achieve its ultimate goal of decreasing the incidence of morbidity and mortality associated with bowel cancer in Australia. This will be achieved under a new paradigm for colonoscopy training and implementation of evidence-based practice across the screening pathway and specifically targeting areas highlighted in this thesis. Recommendations for improvement of NBCSP/QBCSP effectiveness and efficiency include the following: 1. Implementation of NBCSP and QBCSP health promotion activities that target men, in particular, to increase FOBT screening uptake. 2. Improved colonoscopy training for trainees and refresher courses or retraining for existing proceduralists to improve completion rates (especially for female NBCSP/QBCSP participants), and polyp and adenoma detection and removal, including newer techniques to detect flat and depressed lesions. 3. Introduction of colonoscopy training initiatives for trainees that are aligned with NBCSP/QBCSP colonoscopy quality indicators, including measurement of training outcomes using objective quality indicators such as caecal intubation, withdrawal time, and adenoma detection rate. 4. Introduction of standardised, interdisciplinary colonoscopy training to reduce apparent differences between specialties with regard to compliance with guideline recommendations, completion rates, and quality of polypectomy. 5. Improved quality of colonoscopy training by adoption of a UK-style training program with centres of excellence, incorporating newer, more objective assessment methods, use of a variety of training tools such as simulation and rotations of trainees between metropolitan, rural, and public and private sector training facilities. 6. Incorporation of NHMRC guidelines into colonoscopy information systems to improve documentation, provide guideline recommendations at the point of care, use of gastroenterology nurse coordinators to facilitate compliance with guidelines and provision of guideline-based colonoscopy referral letters for GPs. 7. Provision of information and education about the NBCSP/QBCSP, bowel cancer risk factors, including family history and polyp surveillance guidelines, for participants, GPs and proceduralists. 8. Improved referral of NBCSP/QBCSP participants found to have a high-risk family history of bowel cancer to appropriate genetics services.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

The increase of life expectancy worldwide during the last three decades has increased age-related disability leading to the risk of loss of quality of life. How to improve quality of life including physical health and mental health for older people and optimize their life potential has become an important health issue. This study used the Theory of Planned Behaviour Model to examine factors influencing health behaviours, and the relationship with quality of life. A cross-sectional mailed survey of 1300 Australians over 50 years was conducted at the beginning of 2009, with 730 completed questionnaires returned (response rate 63%). Preliminary analysis reveals that physiological changes of old age, especially increasing waist circumference and co morbidity was closely related to health status, especially worse physical health summary score. Physical activity was the least adherent behaviour among the respondents compared to eating healthy food and taking medication regularly as prescribed. Increasing number of older people living alone with co morbidity of disease may be the barriers that influence their attitude and self control toward physical activity. A multidisciplinary and integrated approach including hospital and non hospital care is required to provide appropriate services and facilities toward older people.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

In this article our starting point is the current context of national curriculum change and intense speculation about the assessment, standards and reporting. It is written against a background of accountability measures and improvement imperatives, and focuses attention on standards as offering representations of quality. We understand standards to be constructs that aim to achieve public credibility and utility. Further, they can be examined for the purposes they seek to serve and also their expected functions. Fitness for purpose is therefore a useful notion in considering the nature of standards. Our interest in the discussion is the ‘fit’ between how standards are formulated and how they are used in practice, by whom and for what purposes. A related interest is in the matter of how standards can be harnessed to realise improvement.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

National estimates of the prevalence of child abuse-related injuries are obtained from a variety of sectors including welfare, justice, and health resulting in inconsistent estimates across sectors. The International Classification of Diseases (ICD) is used as the international standard for categorising health data and aggregating data for statistical purposes, though there has been limited validation of the quality, completeness or concordance of these data with other sectors. This research study examined the quality of documentation and coding of child abuse recorded in hospital records in Queensland and the concordance of these data with child welfare records. A retrospective medical record review was used to examine the clinical documentation of over 1000 hospitalised injured children from 20 hospitals in Queensland. A data linkage methodology was used to link these records with records in the child welfare database. Cases were sampled from three sub-groups according to the presence of target ICD codes: Definite abuse, Possible abuse, unintentional injury. Less than 2% of cases coded as being unintentional were recoded after review as being possible abuse, and only 5% of cases coded as possible abuse cases were reclassified as unintentional, though there was greater variation in the classification of cases as definite abuse compared to possible abuse. Concordance of health data with child welfare data varied across patient subgroups. This study will inform the development of strategies to improve the quality, consistency and concordance of information between health and welfare agencies to ensure adequate system responses to children at risk of abuse.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

It would be a rare thing to visit an early years setting or classroom in Australia that does not display examples of young children’s artworks. This practice serves to give schools a particular ‘look’, but is no guarantee of quality art education. The Australian National Review of Visual Arts Education (NRVE) (2009) has called for changes to visual art education in schools. The planned new National Curriculum includes the arts (music, dance, drama, media and visual arts) as one of the five learning areas. Research shows that it is the classroom teacher that makes the difference, and teacher education has a large part to play in reforms to art education. This paper provides an account of one foundation unit of study (Unit 1) for first year university students enrolled in a 4-year Bachelor degree program who are preparing to teach in the early years (0–8 years). To prepare pre-service teachers to meet the needs of children in the 21st century, Unit 1 blends old and new ways of seeing art, child and pedagogy. Claims for the effectiveness of this model are supported with evidence-based research, conducted over the six years of iterations and ongoing development of Unit 1.

Relevância:

100.00% 100.00%

Publicador:

Resumo:

The Australian Commission on Safety and Quality in Health Care commissioned this rapid review to identify recent evidence in relation to three key questions: 1. What is the current evidence of quality and safety issues regarding the hospital experience of people with cognitive impairment (dementia/delirium)? 2. What are the existing evidence-based pathways, best practice or guidelines for cognitive impairment in hospitals? 3. What are the key components of an ideal patient journey for a person with dementia and/or delirium? The purpose of this review is to identify best practice in caring for patients with cognitive impairment (CI) in acute hospital settings. CI refers to patients with dementia and delirium but can include other conditions. For the purposes of this report, ‘Hospitals’ is defined as acute care settings and includes care provided by acute care institutions in other settings (e.g. Multipurpose Services and Hospital in the Home). It does not include residential aged care settings nor palliative care services that are not part of a service provided by an acute care institution. Method Both peer-reviewed publications and the grey literature were comprehensively searched for recent (primarily post 2010) publications, reports and guidelines that addressed the three key questions. The literature was evaluated and graded according to the National Health and Medical Research Council (NHMRC) levels of criteria (see Evidence Summary – Appendix B). Results Thirty-one recent publications were retrieved in relation to quality and safety issues faced by people with CI in acute hospitals. The results indicate that CI is a common problem in hospitals (upwards of 30% - the rate increases with increasing patient age), although this is likely to be an underestimate, in part, due to numbers of patients without a formal dementia diagnosis. There is a large body of evidence showing that patients with CI have worse outcomes than patients without CI following hospitalisation including increased mortality, more complications, longer hospital stays, increased system costs as well as functional and cognitive decline. 4 To improve the care of patients with CI in hospital, best practice guidelines have been developed, of which sixteen recent guidelines/position statements/standards were identified in this review (Table 2). Four guidelines described standards or quality indicators for providing optimal care for the older person with CI in hospital, in general, while three focused on delirium diagnosis, prevention and management. The remaining guidelines/statements focused on specific issues in relation to the care of patients with CI in acute hospitals including hydration, nutrition, wandering and care in the Emergency Department (ED). A key message in several of the guidelines was that older patients should be assessed for CI at admission and this is particularly important in the case of delirium, which can indicate an emergency, in order to implement treatment. A second clear mess...

Relevância:

100.00% 100.00%

Publicador:

Resumo:

Criminological theories of cross-national studies of homicide have underestimated the effects of quality governance of liberal democracy and region. Data sets from several sources are combined and a comprehensive model of homicide is proposed. Results of the spatial regression model, which controls for the effect of spatial autocorrelation, show that quality governance, human development, economic inequality, and ethnic heterogeneity are statistically significant in predicting homicide. In addition, regions of Latin America and non-Muslim Sub-Saharan Africa have significantly higher rates of homicides ceteris paribus while the effects of East Asian countries and Islamic societies are not statistically significant. These findings are consistent with the expectation of the new modernization and regional theories.