Segurança do paciente no sistema de medicação: análise de enfermeiros de um hospital de ensino

This study aimed to identify and describe the factors related to Patient Safety in a medication system according to the nurses analysis in a teaching hospital from the photographic analysis method. This was a cross-sectional, descriptive study with mixed approach in a teaching hospital in Rio Grande do Norte. The population consisted of 42 nurses from inpatient units, of which 34 composed the study sample. As eligibility criteria, we defined nurses from public service and nurses who agreed to participate. Ethical determinations were observed, the study was submitted to the Ethics and Research of the University Hospital Onofre Lopes, obtaining the assent with ethical assessment certificate (CAAE 0098.0.051.294-11). For data collection, we used the photographic method (Photographic Analysis Technique) by Patricia Marck (Canada). It was developed in two phases: at first, we randomly captured photos from the medication system, resulting in 282 images; then we selected/processed the photographs, which were reduced to 10 images in Microsoft Excel 2010; in the second phase, the nurses answered the questionnaire divided into socio-professional profile and Digital Photography Scoring Tool (questions a and b ). For analysis of the question a , we used the content analysis technique, and for b , we used the Statistical Package for the Social Sciences 20.0 (temporary license). The socio-professional profile revealed the predominance of females; age group 34-43 years; professionals with specialization; 10-18 years of length of service; and nurses working exclusively in the hospital and who know the Patient Safety. The photographic analysis in relation to Patient Safety resulted in specific categories for each stage of the medication system. Regarding disposal, we identified Proper verification ; Improper verification ; Correct identification ; Disposal in single doses ; and Improper Environment , with predominance of that last category. As for storage: Proper storage ; Improper storage ; Risk of exchange/disappearance ; and Poor hygiene , with special reference to improper storage. In preparation: Risk of exchanging medication/patient ; Inappropriate physical space ; and Inadequate 9 preparation of controlled drugs , highlighting the first category. In drug administration: Lack of Personal Protective Equipment ; Use of Personal Protective Equipment ; Improper administration technique ; Proper administration technique ; Correct drug identification ; Incorrect drug identification ; and Peripheral venous access without identification . From the safety assessment of 10 photographs, by adapting the scores (1-10) to the Likert Scale, we identified three Totally Unsafe (Level 1), three Unsafe (Level 2), three Partially Safe (Level 3), one Safe (Level 4), and no photograph considered Totally Safe. This study identified the prevalence of unsafety in the medication system in the nurses opinion. We were also able to understand that, although nurses identify safety aspects, the most prevalent categories characterize an unsafe assessment. Nursing needs to reflect on its practice, identifying gaps in the medication system in order to achieve a proper and safe care

Um sistema para gestão do conhecimento em ameaças, vulnerabilidades e seus efeitos

Attacks to devices connected to networks are one of the main problems related to the confidentiality of sensitive data and the correct functioning of computer systems. In spite of the availability of tools and procedures that harden or prevent the occurrence of security incidents, network devices are successfully attacked using strategies applied in previous events. The lack of knowledge about scenarios in which these attacks occurred effectively contributes to the success of new attacks. The development of a tool that makes this kind of information available is, therefore, of great relevance. This work presents a support system to the management of corporate security for the storage, retrieval and help in constructing attack scenarios and related information. If an incident occurs in a corporation, an expert must access the system to store the specific attack scenario. This scenario, made available through controlled access, must be analyzed so that effective decisions or actions can be taken for similar cases. Besides the strategy used by the attacker, attack scenarios also exacerbate vulnerabilities in devices. The access to this kind of information contributes to an increased security level of a corporation's network devices and a decreased response time to occurring incidents

Otimização de forma aplicando B-splines sob critério integral de tensões

This work proposes a computational methodology to solve problems of optimization in structural design. The application develops, implements and integrates methods for structural analysis, geometric modeling, design sensitivity analysis and optimization. So, the optimum design problem is particularized for plane stress case, with the objective to minimize the structural mass subject to a stress criterion. Notice that, these constraints must be evaluated at a series of discrete points, whose distribution should be dense enough in order to minimize the chance of any significant constraint violation between specified points. Therefore, the local stress constraints are transformed into a global stress measure reducing the computational cost in deriving the optimal shape design. The problem is approximated by Finite Element Method using Lagrangian triangular elements with six nodes, and use a automatic mesh generation with a mesh quality criterion of geometric element. The geometric modeling, i.e., the contour is defined by parametric curves of type B-splines, these curves hold suitable characteristics to implement the Shape Optimization Method, that uses the key points like design variables to determine the solution of minimum problem. A reliable tool for design sensitivity analysis is a prerequisite for performing interactive structural design, synthesis and optimization. General expressions for design sensitivity analysis are derived with respect to key points of B-splines. The method of design sensitivity analysis used is the adjoin approach and the analytical method. The formulation of the optimization problem applies the Augmented Lagrangian Method, which convert an optimization problem constrained problem in an unconstrained. The solution of the Augmented Lagrangian function is achieved by determining the analysis of sensitivity. Therefore, the optimization problem reduces to the solution of a sequence of problems with lateral limits constraints, which is solved by the Memoryless Quasi-Newton Method It is demonstrated by several examples that this new approach of analytical design sensitivity analysis of integrated shape design optimization with a global stress criterion purpose is computationally efficient

O trabalho como princípio educativo: algumas reflexões

Após algumas reflexões sobre o conceito de trabalho e formação, este artigo aborda algumas orientações, ou princípios, que podem contribuir para a organização de programas de formação de adultos. Ao trabalhar em programas de formação dessa natureza, devemos ter em mente que trabalhamos com indivíduos que já possuem conhecimentos elaborados, experiências práticas e vivências que devem ser consideradas como ponto de partida. Assim, devemos considerar que a aprendizagem acontece ao longo da vida, e que um curso é apenas parte do percurso de aprendizagem. Outro aspecto importante é que programas de formação para adultos, especialmente aqueles desenvolvidos em situação de trabalho, devem ter sentido para aqueles que irão participar. Os participantes devem, portanto, aderir voluntariamente à proposta; caso contrário, ela poderá ser entendida apenas como algo imposto, e não como um ganho profissional efetivo. Nas situações de formação em situações de trabalho, é também fundamental que os programas sejam elaborados a partir de um apurado conhecimento da realidade daqueles que irão participar. Avaliar e preservar a memória do que foi realizado evita que ocorram eternos recomeços. Por fim, é fundamental que os programas de formação contem também com um programa de apoio aos participantes, de tal forma que eles se sintam mais seguros no trilhar os caminhos das mudanças, quando retornarem aos seus respectivos espaços de trabalho.

Uma proposta para o ensino de eletromagnetismo no nível médio

This paper aims at building a proposal for teaching of electromagnetism in the secondary level in the state public school in Natal, RN, encompassing at the most possible comprehensive manner the fundamental aspects of electromagnetism. The methodology employed here is prioritize physical concepts rather than instruments (such as the mathematics), which should have the connotation of just tools, or of aids in the context of physics teaching in the referred teaching level. The proposal is to give teachers a consultation resource, from differentiated lesson plans, which have as main focus activities based primarily in texts and active participation of students in the teaching- learning process and the implementation of the PCN+ proposals (BRAZIL, 2000), which suggest alternative ways to make the practice in the classroom more exciting, targeting a significant teaching-learning process for both the teacher and the student. This material was applied during the 3rd and 4th term (i.e., bimester) throughout the school year of 2007, in the State School Teacher Varela Barca in two classes (3V1 and 3V2) of 3rd grade of secondary level. As evaluation of the implementation of this proposal one can cite that students were more secure when to apply the concepts, when conducting the experiments, and less anxious when formal evaluation of the evidence, showing greater motivation when presented to electromagnetism contextualized in their everyday situations. The product of this educational work includes, besides the dissertation, the lesson plans, itineraries and experimental assessment of the instruments used (Annex E to I)

(Con)vivendo em fortalezas: o outro lado do morar bem

The intensification of the fear in the city and in the spaces controlled by this feeling has contributed to a growing socio-spatial inequality, and the rapid growth of market protection. The residential condos emerge as a possible solution to the problem. This is a housing typology expanding worldwide which is seen, especially by the urban middle class, as enablers of quality of life and safety. In Brazil, especially in large cities, the quest for quality of life is directly connected with the desire for security translated through space control (use of high walls, gates, entrance hall, security cameras) and people who use it. This thesis aims at investigating how the different categories of inhabitants of an area predominantly occupied by vertical residential condos realize the socio-spatial dimension and the socio-urban space determined by this type of development. It especially takes into consideration the issue of urban insecurity, based on the assumption that, although published and sold by marketing as safe places , synonym of welfare and supporters of community life , the living in these condos, may even inhibits, social relationships, contributing to socio-spatial isolation and consequent social weakness. This is a survey that seeks to meet the assumptions of Environmental Psychology towards the comprehension of person-environment studies, emphasizing the use of different methods (desk research, observations of and group interviews, focus group technique using photographic resources), as well as the focus on current problems of the urban scene and the knowledge gained in Social Psychology

Modelo de risco com dependência entre os valores das indenizações e seus intervalos entre ocorrências

We present a dependent risk model to describe the surplus of an insurance portfolio, based on the article "A ruin model with dependence between claim sizes and claim intervals"(Albrecher and Boxma [1]). An exact expression for the Laplace transform of the survival function of the surplus is derived. The results obtained are illustrated by several numerical examples and the case when we ignore the dependence structure present in the model is investigated. For the phase type claim sizes, we study by the survival probability, considering this is a class of distributions computationally tractable and more general

Anestesia intravenosa total utilizando propofol ou propofol/cetamina em cadelas submetidas à ovariossalpingohisterectomia

Objetivou-se avaliar os efeitos cardiorrespiratório e analgésico da infusão contínua com propofol e propofol/cetamina em cadelas pré-medicadas com atropina e xilazina, submetidas a ovariossalpingohisterectomia (OSH). em seis cadelas (GP) a indução anestésica foi realizada com propofol (5mg kg-1 iv), seguido da manutenção anestésica com o mesmo fármaco em infusão contínua intravenosa na taxa inicial de 0,4mg kg-1.min-1. Outras seis cadelas (GPC) receberam a associação de propofol (3,5mg kg-1 iv) e cetamina (1mg kg-1 iv) como indução anestésica. Depois, foi feita manutenção anestésica em infusão contínua intravenosa inicial com 0,28mg kg-1.min-1 e 0,06mg kg-1.min-1 de propofol e cetamina, respectivamente. Os seguintes parâmetros foram mensurados durante a anestesia a cada 10 minutos: freqüências cardíaca (FC) e respiratória (f), pressão arterial sistólica, média e diastólica (PA), concentração final expirada de CO2 (EtCO2), volume minuto (VM), pressão parcial de gás carbônico (PaCO2), pressão parcial de oxigênio (PaO2), saturação de oxigênio na hemoglobina (SatO2), pH, bicarbonato, glicemia e temperatura retal (T). Observou-se redução da pressão arterial média entre 20 e 40 minutos de anestesia no GP. Ocorreu redução da temperatura, hipercapnia e acidose respiratória em ambos os grupos durante a anestesia. A PaO2, o bicarbonato e a glicose aumentaram de forma significativa apenas no GPC durante a anestesia. Houve necessidade de aumentar em 50 e 20% a taxa de infusão de propofol no GP e GPC respectivamente para anestesia cirúrgica satisfatória. Dessa forma, ambos os protocolos mostraram-se seguros e suficientes do ponto de vista de anestesia cirúrgica para realização da OSH em cadelas, desde que a ventilação assistida ou controlada seja instituída quando necessária e a velocidade de infusão do propofol seja 0,6 e 0,34mg kg-1.min-1 nos grupos GP e GPC, respectivamente.

Segurança no trabalho de preparo de calda no tanque de 2.000l do turbopulverizador com formulações líquidas de agrotóxicos registradas para a cultura de goiaba

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Câncer diferenciado da tiróide de baixo risco: revisão do estado atual da literatura e proposta de conduta

A incidência do câncer diferenciado da tiróide vem aumentando há várias décadas no Brasil, assim como em todo o mundo. A popularização de métodos diagnósticos sensíveis e de uso relativamente simples tem contribuído para o diagnóstico cada vez mais freqüente de carcinomas de pequeno tamanho. Uma parte destes tumores ocorre em pacientes denominados de baixo risco, que poderiam se beneficiar de estratégias de conduta menos agressivas. Entretanto, a definição de baixo risco ainda é confusa e não existem meios seguros para distinguir os pacientes que evoluirão de forma pior dos demais. Por outro lado, o uso de novos métodos de acompanhamento vem mudando a maneira de conduzir estes casos. Um grupo multidisciplinar que inclui pesquisadores básicos, endocrinologistas, médicos nucleares, cirurgiões e patologistas endócrinos reviu a literatura pertinente e, com base em sua experiência, propõe algumas normas de conduta no carcinoma diferenciado da tiróide chamado de baixo risco em nosso meio.

Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility

The present study aimed to estimate the prevalence of elderly using potentially inappropriate medications (PIM) and with occurrence of potentially hazardous drug interactions (PHDI), to identify the risk factors for the prescription of PIM and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. Therefore, a cross-sectional study was performed in a long-term care facility in São Paulo State, between December/2010 and January/2011. The medical records of the patients >= 60 years old who took any drugs were consulted to assess the pharmacotherapeutic safety of the medical prescriptions, in order to identify PIM and PHDI, according to the Beers (2003) and World Health Organization criteria, respectively. PI consisted of a guidance letter to the physician responsible for the institution, with the suggestions of safer equivalent therapeutics. Approximately 88% of the elderly took at least one drug, and for 30% of them the PIM had been prescribed. Most of the PIM identified (53.4%) act on the central nervous system. Among the 13 different DI detected, 6 are considered PHDI. Polypharmacy was detected as a risk factor for PIM prescription. After the PI there was no change in medical prescriptions of patients who had been prescribed PIM or PHDI. The data suggests that PI performed by letter, as the only interventional, method was ineffective. To contribute it a wide dissemination of PIM and PHDI among prescriber professionals is necessary for the selection of safer treatment for elderly. Additionally, a pharmacist should be part of the health care team in order to help promote rational use of medicines.

Protocolo para ensaios físico-químicos de estabilidade de fitocosméticos

The growing demand for stable, safe and effective cosmetics has required increasingly complex studies by the scientific community and the use of more efficient techniques to determine the stability of these products. The use of active principles from the Brazilian flora has led to the development of numerous products, in the most varied pharmaceutical forms, making it, even more difficult to standardize experimental protocols to certify the stability of cosmetic preparations. While in Brazil there is no one protocol that standardizes the tests that should be carried out to determine product stability, several studies have been conducted in academic laboratories to determine the stability of specific raw materials. The rheological properties of topical use products have to be taken into account in their manufacture, storage and application. The determination of the rheological behavior of a formulation helps in evaluating the physicochemical nature of the vehicle, allowing early signs of physical instability to be detected and thus enabling quality control of the constituents, test formulations and final products. Thermal analysis has also been used to assist in the study of cosmetic stability and differential scanning calorimetry to guide the development of new products. Other tools, such as fluorimetry and laser granulometry can be used to help the study and development of both emulsified and non-emulsified systems. The aim of the present study is to develop a protocol for the investigation of the physical and chemical stability of phytocosmetics - systems containing active compounds extracted from the Brazilian biodiversity.

Ensayos sobre el financiamiento de la seguridad social en salud: los casos de Estados Unidos, Canadá, Argentina, Chile y Colombia

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Crecimiento, empleo y equidad: el impacto de las reformas económicas en América Latina y el Caribe

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El desarrollo económico en los albores del siglo XXI

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