Measuring Instruments In Cardiology Adapted Into Portuguese Language Of Brazil: A Systematic Review

This was a systematic review aimed at identifying and characterizing measuring instruments, developed in the context of cardiology, which were adapted into Portuguese language of Brazil. Systematic searches were performed in six databases. Information extracted included cultural adaptation process and measurement properties. To assess the methodological quality of studies, criteria based on international guidelines for cultural adaptation of instruments were used. Among the 114 articles found, 14 were eligible for review. Of these, most evaluated quality of life (35.7%) and health knowledge/learning (28.6%). Most studies followed all stages of the adaptation process recommended in the literature. With respect to measurement properties, internal consistency, verified by Cronbach’s alpha, was the property reported in the majority of the studies, as well as construct and criterion validity. This study is expected to provide to the scientific community a critical evaluation of adapted questionnaires available in the context of cardiology.


EuroCMR (European Cardiovascular Magnetic Resonance) registry: results of the German pilot phase.

OBJECTIVES: During its German pilot phase, the EuroCMR (European Cardiovascular Magnetic Resonance) registry sought to evaluate indications, image quality, safety, and impact on patient management of routine CMR. BACKGROUND: CMR has a broad range of applications and is increasingly used in clinical practice. METHODS: This was a multicenter registry with consecutive enrollment of patients in 20 German centers. RESULTS: A total of 11,040 consecutive patients were enrolled. Eighty-eight percent of patients received gadolinium-based contrast agents. Twenty-one percent underwent adenosine perfusion, and 11% high-dose dobutamine-stress CMR. The most important indications were workup of myocarditis/cardiomyopathies (32%), risk stratification in suspected coronary artery disease/ischemia (31%), as well as assessment of viability (15%). Image quality was good in 90.1%, moderate in 8.1%, and inadequate in 1.8% of cases. Severe complications occurred in 0.05%, and were all associated with stress testing. No patient died during or due to CMR. In nearly two-thirds of patients, CMR findings impacted patient management. Importantly, in 16% of cases the final diagnosis based on CMR was different from the diagnosis before CMR, leading to a complete change in management. In more than 86% of cases, CMR was capable of satisfying all imaging needs so that no further imaging was required. CONCLUSIONS: CMR is frequently performed in clinical practice in many participating centers. The most important indications are workup of myocarditis/cardiomyopathies, risk stratification in suspected coronary artery disease/ischemia, and assessment of viability. CMR imaging as used in the centers of the pilot registry is a safe procedure, has diagnostic image quality in 98% of cases, and its results have strong impact on patient management.

Spatially selective implementation of the adiabatic T2 prep sequence for magnetic resonance angiography of the coronary arteries.

In coronary magnetic resonance angiography, a magnetization-preparation scheme for T2 -weighting (T2 Prep) is widely used to enhance contrast between the coronary blood-pool and the myocardium. This prepulse is commonly applied without spatial selection to minimize flow sensitivity, but the nonselective implementation results in a reduced magnetization of the in-flowing blood and a related penalty in signal-to-noise ratio. It is hypothesized that a spatially selective T2 Prep would leave the magnetization of blood outside the T2 Prep volume unaffected and thereby lower the signal-to-noise ratio penalty. To test this hypothesis, a spatially selective T2 Prep was implemented where the user could freely adjust angulation and position of the T2 Prep slab to avoid covering the ventricular blood-pool and saturating the in-flowing spins. A time gap of 150 ms was further added between the T2 Prep and other prepulses to allow for in-flow of a larger volume of unsaturated spins. Consistent with numerical simulation, the spatially selective T2 Prep increased in vivo human coronary artery signal-to-noise ratio (42.3 ± 2.9 vs. 31.4 ± 2.2, n = 22, P < 0.0001) and contrast-to-noise-ratio (18.6 ± 1.5 vs. 13.9 ± 1.2, P = 0.009) as compared to those of the nonselective T2 Prep. Additionally, a segmental analysis demonstrated that the spatially selective T2 Prep was most beneficial in proximal and mid segments where the in-flowing blood volume was largest compared to the distal segments. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.

O Papel do Serviço Administrativo no Processo de Organização do Sector Educacional

Este trabalho refere-se sobre a importância da administração no processo organizacional do sector educativo. Trata-se de um estudo do caso com foco na escola Secundária Polivalente «Cesaltina Ramos» situado no bairro de Achada Santo António, o bairro mais populoso da cidade da Praia. Em época de complexidades, mudanças e incertezas com a que estamos atravessando hoje, a administração tornou-se umas das mais importantes áreas da actividade humana. Vivemos numa civilização na qual o esforço cooperativo do homem é a base fundamental da sociedade. E a tarefa básica da administração é fazer as coisas por meio das pessoas de maneira eficiente, eficaz e económico, seja nas instituições, organizações ou em qualquer forma de empreendimento humano, trabalham em conjunto para conseguir objectivos comuns de que depende directamente da capacidade daqueles que exercem funções administrativos. O avanço tecnológico e o desenvolvimento do conhecimento humano, por si apenas não produzem efeitos se a qualidade da administração efectuada sobre os grupos organizados de pessoas não permitir uma efectiva racionalização dos recursos humanos e materiais.

Early detection of idiopathic Parkinson's disease based on magnetic resonance imaging

The diagnosis of idiopathic Parkinson's disease (IPD) is entirely clinical. The fact that neuronal damage begins 5-10 years before occurrence of sub-clinical signs, underlines the importance of preclinical diagnosis. A new approach for in-vivo pathophysiological assessment of IPD-related neurodegeneration was implemented based on recently developed neuroimaging methods. It is based on non- invasive magnetic resonance data sensitive to brain tissue property changes that precede macroscopic atrophy in the early stages of IPD. This research aims to determine the brain tissue property changes induced by neurodegeneration that can be linked to clinical phenotypes which will allow us to create a predictive model for early diagnosis in IPD. We hypothesized that the degree of disease progression in IPD patients will have a differential and specific impact on brain tissue properties used to create a predictive model of motor and non-motor impairment in IPD. We studied the potential of in-vivo quantitative imaging sensitive to neurodegeneration- related brain tissue characteristics to detect changes in patients with IPD. We carried out methodological work within the well established SPM8 framework to estimate the sensitivity of tissue probability maps for automated tissue classification for detection of early IPD. We performed whole-brain multi parameter mapping at high resolution followed by voxel-based morphometric (VBM) analysis and voxel-based quantification (VBQ) comparing healthy subjects to IPD patients. We found a trend demonstrating non-significant tissue property changes in the olfactory bulb area using the MT and R1 parameter with p<0.001. Comparing to the IPD patients, the healthy group presented a bilateral higher MT and R1 intensity in this specific functional region. These results did not correlate with age, severity or duration of disease. We failed to demonstrate any changes with the R2* parameter. We interpreted our findings as demyelination of the olfactory tract, which is clinically represented as anosmia. However, the lack of correlation with duration or severity complicates its implications in the creation of a predictive model of impairment in IPD.

Management of basic health units in municipalities of different size: profile and management instruments

Objective To identify the characteristics of managers and their use of management instruments in primary care and to analyze differences in these features among municipalities of different sizes. Method The present cross-sectional descriptive study was conducted at 108 basic health units from 21 municipalities in northern Paraná, Brazil. The data were collected using a semi-structured questionnaire during the second half of 2010. Results Most managers had graduate degrees and were female and nurses. The managers from the small municipalities were younger, their payment was lower, and they had less work experience. The use of management instruments was expressive for both the organization and work management; however, the instruments were used less in the small municipalities. Conclusion The managers were committed to their role; it is recommended that policies and guidance should be formulated at the federal and state levels to support small municipalities.

Use of patients’ classification instruments: analysis of the brazilian production of knowledge

Objective To analyze the production of scientific knowledge about the use of patients’ classification instruments in care and management practice in Brazil. Method Integrative literature review with databases search in: Latin American and Caribbean Literature on Health Sciences (LILACS), Medical Literature Analysis and Retrieval System on-line (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and SCOPUS, between January 2002 through December 2013. Results 1,194 studies were found, 31 met the inclusion criteria. We observed a higher number of studies in the category care plans and workload (n=15), followed by the category evaluation of psychometric properties (n=14). Conclusion Brazilian knowledge production has not yet investigated some purposes of using instruments for classifying patients in professional nursing practice. The identification of unexplored areas can guide future research on the topic.


Examining the Agreement of Structural Loss Measured With Heidelberg Retinal Tomograhy and Functional Loss With Standard Automated Perimetry (SAP; Octopus), Pulsar Perimetry (PP), and Moorfields Motion Displacement Test (MDT) Perimetry

Purpose: To examine the relationship of functional measurements with structural measures. Methods: 146 eyes of 83 test subjects underwent Heidelberg Retinal Tomography (HRTIII) (disc area<2.43, mphsd<40), and perimetry testing with Octopus (SAP; Dynamic), Pulsar (PP; TOP) and Moorfields MDT (ESTA). Glaucoma was defined as progressive structural or functional loss (20 eyes). Perimetry test points were grouped into 6 sectors based on the estimated optic nerve head angle into which the associated nerve fiber bundle enters (Garway-Heath map). Perimetry summary measures (PSM) (MD SAP/ MD PP/ PTD MDT) were calculated from the average total deviation of each measured threshold from the normal for each sector. We calculated the 95% significance level of the sectorial PSM from the respective normative data. We calculated the percentage agreement with group1 (G1), healthy on HRT and within normal perimetric limits, and group 2 (G2), abnormal on HRT and outside normal perimetric limits. We also examined the relationship of PSM and rim area (RA) in those sectors classified as abnormal by MRA (Moorfields Regression Analysis) of HRT. Results: The mean age was 65 (range= [37, 89]). The global sensitivity versus specificity of each instrument in detecting glaucomatous eyes was: MDT 80% vs. 88%, SAP 80% vs. 80%, PP 70% vs. 89% and HRT 80% vs. 79%. Highest percentage agreement of HRT (respectively G1, G2, sector) with PSM were MDT (89%, 57%, nasal superior), SAP (83%, 74%, temporal superior), PP (74%, 63%, nasal superior). Globally percentage agreement (respectively G1, G2) was MDT (92%, 28%), SAP (87%, 40%) and PP (77%, 49%). Linear regression showed there was no significant trend globally associating RA and PSM. However, sectorally the supero-nasal sector had a statistically significant (p<0.001) trend with each instrument, the associated r2 coefficients are (MDT 0.38 SAP 0.56 and PP 0.39). Conclusions: There were no significant differences in global sensitivity or specificity between instruments. Structure-function relationships varied significantly between instruments and were consistently strongest supero-nasally. Further studies are required to investigate these relationships in detail.

Systematic review of meaning in life assessment instruments.

BACKGROUND: The construct of "meaning in life" (MiL) has raised the interest of clinicians working in psycho-oncology and end-of-life care. It has become a topic of scientific investigation where diverse assessment approaches have been applied. Aims: We present a comprehensive systematic review of existing MiL assessment instruments. METHODS: Electronic searches of articles published in English peer-reviewed journals were performed in Psycinfo, Medline, Embase and Cinahl. Instruments are appraised with regard to ten measurement properties. RESULTS: In total, 59 nomothetic and idiographic MiL instruments were identified. Most instruments were developed in North America and meet basic psychometric criteria. They assess presence of and search for MiL, crisis and sources of MiL, meaning making, meaningful activity, MiL in the context of illness, breadth, depth, and other structural indicators. These aspects are largely consistent with existing MiL definitions. Nine out of 59 instruments included cancer populations in test development. CONCLUSIONS: This overview of available instruments underscores the complexity of the construct and might assist researchers to select an appropriate instrument for their research needs. Finally, it points to the need for more integrative theorizing and research on MiL. Copyright © 2012 John Wiley & Sons, Ltd.

Imaging of tophaceous gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography.

OBJECTIVE: To determine the usefulness of computed tomography (CT), magnetic resonance imaging (MRI), and Doppler ultrasonography (US) in providing specific images of gouty tophi. METHODS: Four male patients with chronic gout with tophi affecting the knee joints (three cases) or the olecranon processes of the elbows (one case) were assessed. Crystallographic analyses of the synovial fluid or tissue aspirates of the areas of interest were made with polarising light microscopy, alizarin red staining, and x ray diffraction. CT was performed with a GE scanner, MR imaging was obtained with a 1.5 T Magneton (Siemens), and ultrasonography with colour Doppler was carried out by standard technique. RESULTS: Crystallographic analyses showed monosodium urate (MSU) crystals in the specimens of the four patients; hydroxyapatite and calcium pyrophosphate dihydrate (CPPD) crystals were not found. A diffuse soft tissue thickening was seen on plain radiographs but no calcifications or ossifications of the tophi. CT disclosed lesions containing round and oval opacities, with a mean density of about 160 Hounsfield units (HU). With MRI, lesions were of low to intermediate signal intensity on T(1) and T(2) weighting. After contrast injection in two cases, enhancement of the tophus was seen in one. Colour Doppler US showed the tophi to be hypoechogenic with peripheral increase of the blood flow in three cases. CONCLUSION: The MR and colour Doppler US images showed the tophi as masses surrounded by a hypervascular area, which cannot be considered as specific for gout. But on CT images, masses of about 160 HU density were clearly seen, which correspond to MSU crystal deposits.

Pouvoir discrétionnaire et redevabilité de la bureaucratie de guichet : les taxateurs d'une caisse de chômage comme acteurs de mise en oeuvre

Résumé en français La thèse de doctorat porte, de manière générale, sur le rôle des acteurs administratifs dans la mise en oeuvre de l'action publique. En particulier, dans le contexte de l'implémentation de la politique suisse d'assurance-chômage, la recherche se focalise sur l'étude de la bureaucratie de guichet, à savoir un type spécifique d'administrations et d'agents publics situés aux premières lignes de l'action étatique et qui sont en contact direct et quotidien avec les usagers. La thèse a pour objectif principal d'obtenir une compréhension détaillée des impacts concrets dont sont porteurs deux types de réformes majeures du secteur public : les réformes de Nouvelle Gestion Publique (NGP) et les nouvelles technologies informatiques. Le questionnement central de la recherche consiste en une étude approfondie des effets de ces réformes sur les bureaucraties de guichet, et en particulier sur deux aspects centraux les concernant : d'une part, le niveau de pouvoir discrétionnaire que les agents publics de base disposent dans l'application de la loi fédérale sur l'assurance-chômage, autrement dit leur marge de manoeuvre ; d'autre part, les manières au travers desquelles ces mêmes agents sont appelés à rendre des comptes quant à leurs actions et leurs décisions, à savoir l'enjeu plus large de la redevabilité publique des acteurs administratifs. Ces enjeux ont été analysés au niveau empirique dans le contexte organisationnel d'une caisse publique cantonale de chômage ayant expérimenté les réformes évoquées ci-dessus. L'organisation choisie a été investiguée au travers d'une étude de cas ethnographique approfondie (observation directe du travail quotidien des agents, entretiens semi-directifs, analyse de documents) pendant une période de six mois environ entre 2008 et 2009. L'analyse empirique fournit quatre résultats : a) de manière générale, les taxateurs de la caisse de chômage disposent d'un faible niveau de pouvoir discrétionnaire ; b) le degré de pouvoir discrétionnaire varie selon le type de tâche ; c) les agents sur le terrain rendent des comptes auprès d'une multiplicité d'acteurs, sur une variété d'aspects de leur travail et au travers de différents mécanismes de contrôle ; d) les outils de NGP et les nouvelles technologies informatiques ont peu d'impact sur l'étendue du pouvoir discrétionnaire des agents mais contribuent à influencer le type de redevabilité publique pratiquée à ce niveau. Summary in English This PhD dissertation deals with the role of public administration in policy implementation. In the Swiss context of unemployment insurance policy, it focuses on street-level bureaucracy, a specific type of public organisations and agents located at the frontline of public action, that is to say low-level civil servants who are in direct, daily and face-to-face contact with citizens. The dissertation aims at a deep understanding of what are the concrete impacts of two main important changes touching public sector organizations : New Public Management reforms (NPM) and Information and Communication technologies (ICT). The main research question consists in assessing the impacts of those reforms on two central issues regarding street-level bureaucrats : on the one hand, the effective degree of discretion frontline agents do have in implementing the federal law on unemployment insurance ; on the other hand, the ways through which these bureaucrats are held accountable about their action and decisions, i.e. accountability regimes at the street-level. These issues have been empirically addressed in the organisational context of a cantonal Unemployment Insurance Funds having experienced the above mentioned reforms. The organisation has been investigated through an in-depth ethnographic case-study (direct observation of daily work, semi-structured interwiews, documentary analysis) in 2008 and 2009 for approximately six months. The empirical analysis indicates that a) in general, street-level agents do exert low degree of policy discretion; b) the level of discretion is variable from one specific task to another ; c) frontline workers are held accountable to many actors, on various aspects of their work and through different mechanisms of control ; d) NPM and ICT instruments have few impact on the issue of policy discretion but more on the type of street-level accountability which is concretely practised at this level.

Terceiro Sector Governabilidade e Balanced Scorecard

A presente dissertação descreve abordagens de governo de organizações do terceiro sector e apresenta um estudo de caso de aplicação do balanced scorecard como instrumento de gestão estratégica numa destas organizações em Cabo Verde. As fronteiras entre os sectores público, sector privado e o Terceiro Sector tendem a ficar fluidas tendo cada um assimilado as características dos outros, procurando respostas para as necessidades sociais. Assim, organizações do terceiro sector procuram por exemplo enfoque no cliente e na gestão financeira tal como as empresas, e estas procuram dar destaque na responsabilidade social tal como organizações sem fins lucrativos. As organizações do terceiro sector necessitam cada vez mais de métodos administrativos e profissionais para os desafios da economia global, nomeadamente na competição por recursos e simultâneamente no fortalecimento dos laços com as comunidades no cumprimento da sua missão. O governo de uma organização pressupõe um sistema de indicadores do desempenho para dar satisfação a diferentes stakeholders ou constituintes com interesses contraditórios. A dissertação responde a questões de adaptação dos conceitos e métodos de avaliação do desempenho empresarial em diferentes ópticas para organizações do terceiro sector com um estudo de caso de aplicação do Balanced Scorecard. Este instrumento de gestão conceptualizado e testado desde 1992 para empresas de negócios, equilibra as perspectivas financeira, clientes, de processos, e de apendizagem organizacional, permitindo de forma extracontabilistica equilibrar todas as vertentes de uma organização para além dos recursos financeiros, para economia da satisfação e das pessoas.

ANÁLISE DE INVESTIMENTOS: UM CASO ESPECÍFICO NO SECTOR IMOBILIÁRIO – SANTO ANTÃO

O presente trabalho tem como objectivo apresentar um estudo sobre a análise de investimentos. Este estudo vai incidir preferencialmente sobre o sector imobiliário. Este trabalho propõe-se identificar os problemas que ocorrem, quando se decide fazer um investimento. Para tal, a fundamentação teórica irá abordar alguns conceitos fundamentais a ter na análise de investimentos, uma análise do meio envolvente externo geral (Cabo Verde) que se deve ter em atenção quando se faz qualquer investimento. Além disto, irá ser feita uma análise do investimento imobiliário em cabo Verde, uma relação entre a sensibilidade e o risco na análise dos investimentos, fazer um enquadramento do tema no Novo Normativo Contabilístico e por fim um estudo de caso que vai incidir sobre um projecto de investimento de uma empresa do nosso mercado, que opera no sector imobiliário, onde iremos empregar alguns critérios de análise de investimentos, e desta forma saber se é viável ou não investir no sector em cabo verde mais concretamente em Santo Antão

Contabilização dos Activos Biológicos – Caso Específico no Sector Aviário – Sociave

O presente trabalho tem por objectivo principal sistematizar os principais conceitos relacionados com a mensuração, reconhecimento, apresentação e divulgação nas demonstrações financeiras dos activos biológicos tais como animais e plantas. Num momento de mudança de normativo contabilístico nacional e considerando que o anterior era muito escasso em termos normativos para este sector que consideramos sensível para algumas empresas do mercado, entendemos que seria de todo o interesse levantarmos questões, sistematizar conceitos, e abordar este assunto privilegiado os aspecto de reconhecimento e mensuração. O presente trabalho inicia com questões de enquadramento e contextualização do tema, definimos os objectivos do trabalho, a estrutura, a metodologia utilizada para na abordagem do tema e referências relativa à sua utilidade académica. Em seguida temos os aspectos de conceitos, teórico e normativo nacional e aspectos conceptuais em normativos internacionais que permitem uma melhor compreensão do tema e conhecer o tratamento contabilístico (mensuração, reconhecimento, apresentação e divulgação) dado pelos dois normativos. Dedicamos um capítulo para o estudo do caso da empresa SOCIAVE, SARL onde, alem de apresentarmos a empresa, utilizamos as informações internas (gentilmente cedidos pela gerência) para ilustrarmos a abordagem do tema.

Aplicação da Teoria dos Constrangimentos ao Sector de Transporte Público Colectivo – O Caso Da Transcor-Sv, S.A. –

Com a necessidade de adaptação às crescentes mudanças no mundo dos negócios, ao longo dos últimos anos a contabilidade de gestão tem sido criticada, pois os métodos de custeio tradicionalmente utilizados, não estão acompanhando estas mudanças, incapacitando a utilização destes como instrumentos de gestão eficazes. Na busca de ferramentas de gestão para auxiliar na tomada de decisão, foi desenvolvida a Teoria dos Constrangimentos (TOC) ou das Restrições, uma ferramenta de gestão cuja premissa é a identificação de constrangimentos que limitem a capacidade da empresa no alcance da sua meta. Muito se tem escrito sobre a aplicação desta teoria em empresas industriais, uma vez que, nessas organizações a existência de constrangimentos está mais presente. Tendo como objectivo verificar a viabilidade de aplicação desta teoria na actividade de prestação de serviços, o presente trabalho refere-se ao estudo de caso numa empresa de prestação de serviço de transporte público colectivo de passageiros TRANSCOR-SV,S.A., localizada na ilha de São Vicente. Para tal, identificámos factores considerados constrangimentos nos sistemas de transporte colectivo, através da aplicação de um questionário. Com estes factores em mãos, aplicámos a metodologia baseada no Processo de Raciocínio (PR) da OC. With the need of adaption to the growing changes happening in the business world, throughout the last few years, management accounting has been much criticized for the methods of costing used are not following such changes, turning the use of these meth-ods powerless to help provide an effective management in companies. In the search for creating useful tools to help guarantee effectiveness in decision making in companies, the Constraint Theory, or Restriction Theory, was created as a management tool in which the fundamental objective is to identify constraints that limit the capacity of a company to reach its goals successfully. Much has been written about the application of this theory in corporate industries, once in such business the existence of constraints is very present. With the aim of verifying the viability of its use in service rendered in collective public transport, this work is characterized by the case study of one such company in São Vicente. Initially, some factors that can be seen as constraints were identified in the public transport service, through the use of a questionnaire. With the results, follows the employ of the Thinking Process methodology in the analysis based in the Theory of Constraint.