Gestión de calidad en programas de maestría / Quality Management on Master's Programs

Introducción: La acreditación en la Universidad de Ciencias Médicas de La Habana se inició en 2002. Desde entonces se han efectuado un total de 41 procesos de evaluación externa en 25 programas de maestría. Objetivo: Describir la gestión de calidad para programas de maestría en la Universidad de Ciencias Médicas de La Habana. Métodos: Se realizó una investigación descriptiva transversal en el primer trimestre de 2021, para lo cual se emplearon métodos y procedimientos cuali-cuantitativos. Resultados: De los programas autorizados, 7 perdieron su condición de acreditación por diferentes causas; 18, de los cuales 10 eran de excelencia, 6 certificados y 2 calificados, tuvieron una categoría superior a la autorizada; 4 estaban concebidos para realizar procesos de evaluación externa a distancia en 2021 y se previó que otros 13 lo hicieran en 2022. La situación actual de la pandemia de la COVID-19 propició que los programas de maestrías asumieran diversas modalidades para dar continuidad a su ejecución, al considerar las orientaciones de la Junta de Acreditación Nacional. En los documentos revisados se destacó la ejecución de Proyecto de Investigación Aplicada. Conclusiones: La gestión de calidad para programas de maestrías avanza con los años. Poseen categoría de acreditación superior aquellos acreditables, con predominio de la categoría de excelencia. Están proyectados los procesos de evaluación externa para 2021 y 2022, y se ejecuta un Proyecto de Investigación Aplicada que consolida las acciones de esta estrategia(AU)

Introduction: Accreditation at the University of Medical Sciences of Havana began in 2002. Since then, a total of 41 external assessment processes have been carried out in 25 master's programs. Objective: To describe quality management for master's programs at the University of Medical Sciences of Havana. Methods: A cross-sectional and descriptive research was carried out in the first quarter of 2021, for which qualitative-quantitative methods and procedures were used. Results: Of the authorized programs, seven lost their accreditation status for different reasons. Eighteen, of which ten were of excellence, six were certified and two were qualified, had a category higher than the authorized one. Four were conceived to carry out remote external assessment processes in 2021, while another thirteen were expected to do so in 2022. The current situation of the COVID-19 pandemic led to the master's programs taking on various modalities to give continuity to their execution, upon considering the orientations from the National Accreditation Board. The documents reviewed highlighted the implementation of the Applied Research Project. Conclusions: Quality management for master's programs advances over the years. Those creditable have a higher accreditation category, with a predominance of the excellence category. The external assessment processes are projected for 2021 and 2022, while an Applied Research Project is being executed and consolidates the actions of this strategy(AU)

Consideraciones actuales concernientes al tratamiento del plastrón apendicular / Current Considerations Concerning Treatment of Appendiceal Plastron

Introducción: El plastrón apendicular es una tumoración inflamatoria constituida por el apéndice inflamado, vísceras adyacentes y epiplón mayor. Puede contener o no pus (absceso/flemón). Objetivo: Precisar si está indicada la apendicectomía de urgencia o de intervalo en los pacientes con plastrón y/o absceso apendicular sometidos a tratamiento no quirúrgico inicial. Métodos: Se realizó una revisión en las bases de datos bibliográficas Web of Science, PubMed, Medline y Lilacs, mediante el motor de búsqueda Google académico. Se seleccionaron 28 artículos en inglés y español; 20 (71,2 por ciento) correspondieron al quinquenio 2016-20 y el 96,4 por ciento de autores extranjeros. Desarrollo: El estándar actual es el tratamiento no quirúrgico inicial del plastrón y el drenaje percutáneo del absceso. La apendicectomía de intervalo tiene un beneficio mínimo y puede conducir a un aumento de los costos, estancia hospitalaria, antibioticoterapia intravenosa y de la morbilidad. Se debe realizar un seguimiento cuidadoso en enfermos con riesgo de enfermedad inflamatoria intestinal o cáncer de colon, sin importar qué opción se elija (operación de intervalo u observación). Conclusiones: La apendicectomía de urgencia no es recomendable porque el componente inflamatorio la hace técnicamente difícil, puede necesitar una colectomía y aumentar la morbilidad, aunque actualmente, la apendicectomía laparoscópica de urgencia puede ser más rentable y segura. La decisión posterior de la apendicectomía a intervalos sigue siendo discutible. El intervalo recomendado varía entre 6 y 8 semanas, tres y seis meses después de la normalización clínico humoral(AU)

Introduction: Appendiceal plastron is an inflammatory tumor made up of inflamed appendix, adjacent viscera and greater omentum. It may or may not contain pus (abscess/phlegmon). Objective: To specify whether emergency or interval appendectomy is indicated in patients with appendicular abscess and/or plastron who had undergone initial nonsurgical treatment. Methods: A review was carried out in the bibliographic databases Web of Science, PubMed, Medline and Lilacs, using the search engine Google Scholar. Twenty-eight articles were selected, in English and Spanish; twenty (71.2 percent) corresponded to the quinquennium 2016-20, while 96.4 percent were written by foreign authors. Development: The current standard is the initial nonsurgical treatment of the plastron and percutaneous drainage of the abscess. Interval appendectomy has minimal benefits and can lead to increased costs, hospital stay, intravenous antibiotic therapy and morbidity. Patients at risk for inflammatory bowel disease or colon cancer should be carefully followed up, regardless of which option is chosen (interval operation or observation). Conclusions: Emergency appendectomy is not recommended because the inflammatory component makes it technically difficult; it may require colectomy and increase morbidity, although currently, emergency laparoscopic appendectomy may be more profitable and safer. The subsequent decision for interval appendectomy remains debatable. The recommended interval varies from six to eight weeks, three and six months after clinical-humoral normalization(AU)

Modelo para el perfeccionamiento del proceso de atención en cirugía mayor ambulatoria y de corta estadía / A Model for Improving the Care Process in Major Outpatient and Short-Stay Surgeries

Introducción: Existen limitaciones en la coordinación entre los niveles primario y secundario de salud en el proceso quirúrgico ambulatorio y de corta estadía, lo que repercute en la calidad del servicio. Objetivo: Diseñar una propuesta de modelo asistencial para el perfeccionamiento del proceso de atención al paciente en cirugía mayor ambulatoria y cirugía de corta estadía. Métodos: Se desarrolló una investigación prospectiva descriptiva del 3 de septiembre de 2012 al 20 de marzo de 2018. En su diseño fueron empleados la modelación y el sistémico-estructural fundamentalmente. Se aplicaron encuestas a expertos con experiencia en los niveles primario y secundario de salud para evaluar la calidad y pertinencia del modelo propuesto. También fueron encuestados los jefes de los grupos provinciales de Cirugía General y Medicina Familiar. Se realizaron entrevistas grupales a clientes del proyecto de investigación (del que se deriva) y a decisores institucionales y del nivel provincial. Fue empleada la técnica de triangulación metodológica y de fuentes. Resultados: La estructuración del modelo partió de la coordinación del trabajo asistencial y metodológico entre los niveles primario y secundario de salud. Se sustentó en cuatro pilares: preparación teórica del personal de salud, observancia de normas de relación en el contexto laboral, cumplimiento de procedimientos en el contexto asistencial y evaluación continua de la calidad asistencial. Los expertos, clientes y decisores avalaron su calidad, pertinencia y posibilidades de implementación. Conclusiones: El modelo presenta calidad, es pertinente y su aplicación es factible(AU)

Introduction: There are limitations in the coordination between the primary and secondary health levels in the outpatient and short-stay surgical processes, which affects the quality of the service. Objective: Designing a proposal for a healthcare model for the improvement of the patient care process in major outpatient surgery and short-stay surgery. Methods: A descriptive and prospective research was carried out from September 3, 2012 to March 20, 2018. Its design involved essentially modeling and the systemic-structural method. Surveys were applied to experts with experience in primary and secondary health levels, in order to assess the quality and relevance of the proposed model. The heads of the provincial groups of General Surgery and Family Medicine were also surveyed. Group interviews were conducted with clients of the research project (from which it is derived) and with institutional and provincial decision-makers. The methodological and source triangulation technique was used. Results: The structuring of the model started from the coordination of the care and methodological work between the primary and secondary health levels. It was based on four pillars: theoretical training of health personnel, observance of relationship rules in the work context, compliance with procedures in the care context, and continuous assessment of the quality of care. The experts, clients and decision-makers recognized its quality, relevance and possibilities of implementation. Conclusions: The model presents quality, is pertinent and its application is feasible(AU)

A Clinical Study of Acute Epiglottitis: Retrospective Review of 315 Patients in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute epiglottitis is a life-threatening condition that can result in airway obstruction. The present study reports clinical features, management and patient outcomes in an acute epiglottitis. SUBJECTS AND METHOD: Included in our retrospective study were 315 patients who were admitted with the diagnosis of acute epiglottitis between January 2006 and July to the department Otolaryngology-Head and Neck surgery, Hallym University Sacred Heart Hospital 2018. The diagnosis of acute epiglottitis was established by confirmation of inflamed epiglottis using laryngoscope or computed tomography. RESULTS: Among 315 patients, 89 cases (28%) and 83 cases (26%) were found in the fifth and fourth decades, respectively. The mean age of patients was 45.0±13.94 years. The male to female ratio was 1.33:1. A total of 75 patients (23.8%) had co-morbidities, with hypertension (13.6%) being the most common. Fever was relatively uncommon, whereas most patients complained of sore throat. Ceftriaxone was the most common empirical antibiotic regimen prescribed and the use of steroids did not affect the length of hospital stay. Nine patients required airway intervention, including eight who underwent endotracheal intubation and one emergency tracheostomy. In patients who need airway intervention, systolic blood pressure, body temperature, respiratory rate, heart rate, white blood cells and the proportion of dyspnea were significantly higher in comparison to the patients without airway intervention. CONCLUSION: Although acute epiglottitis often has nonspecific symptoms, it may lead to sudden dyspnea and unstable vital signs, so an in-depth understanding of this disease is needed.

Estrategias de contabilidad de gestión aplicada a pymes revisión literaria / Management accounting strategies applied to smes literary review / Estratégias de contabilidade de gestão aplicado às pme revisão da literatura

Resumen Introducción: La contabilidad evolucionó de la técnica a la aplicación del control de gestión optimizando los procesos empresariales. Las pymes son un segmento de las empresas que aplicando herramientas de gestión mejoran significativamente control de costos y el desempeño organizacional. Objetivo: Este trabajo tuvo como objetivo destacar las estrategias de contabilidad de gestión aplicada por las Pymes y cómo aportaron a la sostenibilidad de las empresas en el mercado, a través de una revisión documental. Materiales y métodos: Se aplicó un enfoque cualitativo de la investigación, con la aplicación de métodos teóricos, como análisis-síntesis e histórico lógico, y técnicas empíricas como la revisión documental. Se utilizaron las tres etapas del instrumento ProKnow-C. para la revisión de 13 artículos publicados durante el período 1969-2018, en revistas de economía y empresa obtenidos a partir de la base de datos web of Science y Scopus utilizando las palabras clave Managment accounting in Smes, stategic magnament accounting, managment accounting and small entrerprise. Resultados: 4827 artículos relacionados en el campo de las ciencias sociales, seleccionando 13 relacionados a investigación de control de gestión y estrategias aplicadas en el segmento de pymes. Conclusiones: El contenido resultante señaló implementación de ERP, aplicación de cuadro de mando integral y balance scorecard conllevan a la planeación y control de las organizaciones.

Abstract Introduction: The accounting evolved from the technique to the application of the management control optimizing the business processes. SMEs are a segment of companies that apply management tools significantly improve cost control and organizational performance. Objective: This work aimed to highlight the management accounting strategies applied by SMEs and how they contributed to the sustainability of companies in the market, through a documentary review. Materials and methods: It applied a qualitative approach to research, with the application of theoretical methods such as analysis-synthesis and logical history, and empirical techniques such as documentary review. The three stages of the Proknow-C instrument were used. For the revision of 13 articles published during the period 19692018, in magazines of economy and company obtained from the database web of Science and Scopus using the keywords Management accounting in SMEs, Strategic management accounting. Results: 4827 related articles in the field of social sciences, selecting 13 related to management control research and applied strategies in the SMES segment. Conclusions: The resulting content indicated implementation of ERP, integral scorecard application and balancesheet, which lead to the planning and control of the organizations.

Resumo Introdução: técnica de contabilidade evoluiu a partir da aplicação de controlo de gestão, otimizando processos de negócios. As PME são um segmento de empresas que aplicam ferramentas de gerenciamento de melhorar significativamente o controle de custos e desempenho organizacional. Objetivo: Este trabalho teve como objetivo destacar as estratégias de contabilidade gerencial aplicadas pelas PMEs e como elas contribuíram para a sustentabilidade das empresas no mercado, por meio de uma revisão documental. Materiais e Métodos: Aplicou uma abordagem qualitativa à pesquisa, com a aplicação de métodos teóricos, como análise-síntese e história lógica, e técnicas empíricas, como a revisão documental. Os três estágios do instrumento ProKnow-C foram utilizados. para a revisão de 13 artigos publicados no período de 1969 a 2018, em periódicos de economia e negócios obtidos no banco de dados web da Science e Scopus utilizando as palavras-chave Contabilidade de gestão em Pmes, contabilidade magning estratégica, contabilidade gerencial e pequena Empresa. Resultados: 4827 artigos no campo das ciências sociais, a seleção de 13 pesquisas relacionadas a estratégias de gestão e de controlo aplicados no segmento de PME. Conclusões: O conteúdo resultante apontou implementação de ERP, scorecard aplicação e chumbo balance scorecard para o planejamento e controle das organizações.

Envolvimento dos pacientes no gerenciamento da qualidade dos serviços de saúde / Patient involvement in quality management of healthcare services

Resumo Objetivo: Identificar o estágio de envolvimento dos pacientes nas Instituições de saúde brasileiras, nos programas de melhoria da qualidade e segurança. Métodos: Abordagem quantitativa, através de uma pesquisa de avaliação com 141 Instituições, localizadas em 18 estados e no Distrito Federal, no período de fevereiro a maio de 2016. Para coleta dos dados foi aplicado um questionário pela web, utilizando o software de questionários e pesquisas SurveyMonkeyÓ. No questionário, além das perguntas para caracterização das Instituições e dos respondentes, sete perguntas foram relacionadas às atividades de participação dos pacientes nos processos de gerenciamento da qualidade. Resultados: As atividades realizadas pela maior parte das Instituições foram “pesquisa de satisfação dos pacientes” e “processo formal para comunicação com os pacientes em relação às suas dúvidas, sugestões e reclamações”. A média de atividades realizadas foi de 3,84 de um total de 7 atividades avaliadas. Conclusão: Considerando uma escala de 0 a 3, aproximadamente 70% das Instituições foram classificadas entre os estágios 0 (paciente não é envolvido) e 1 (participação na avaliação das metas de qualidade).

Abstract Objective: To identify the stage of patient involvement in quality and safety improvement programs in Brazilian healthcare institutions. Methods: A quantitative approach with 141 institutions located in 18 states and the Federal District, using an assessment survey from February to May of 2016. Data collection occurred via a questionnaire on the Web, using the SurveyMonkeyÓ online survey & questionnaire software. The questionnaire included questions to characterize the institutions and respondents, and seven questions related to the participation of patients in the quality management process. Results: The activities performed by most of the institutions were “patient satisfaction surveys” and “formal process for communication with patients regarding their questions, suggestions and complaints”. The mean number of activities performed was 3.84 out of the seven activities evaluated. Conclusion: Assuming a scale from 0 to 3, approximately 70% of the institutions were classified between stage 0 (patient is not involved) and 1 (participation in evaluation of the quality goals).

Hipertensión arterial en niños y adolescentes, una perspectiva clínica en constante, una perspectiva clínica en constante evolución

La hipertensión arterial es un padecimiento caracterizado por un aumento persistente de la tensión arterial. La prevalencia en niños es significativamente menor que en adultos y fluctúa entre 1 y 3%. Se describen las cifras de normalidad en base al cuarto documento sobre diagnóstico, evaluación y tratamiento del National High Blood Pressure Education Program (NHBPEP). La hipertensión puede ser primaria o secundaria, cuando existe alguna causa, casi siempre es debida a enfermedades renales. El tratamiento depende de la causa y puede ser médico ( Cambio en el estilo de vida, farmacológico) o quirúrgico. A pesar de que la prevalencia de hipertensión arterial en la población pediátrica es baja, los casos de emergencia y urgencia hipertensiva pueden presentarse en el cuarto de urgencias. El manejo eficiente de estos niños es importante para evitar las complicaciones a largo plazo asociadas a la hipertensión y su tratamiento. La intención de este artículo consiste en revisar los aspectos más importante sobre la hipertensión arterial en pediatría, incluyendo definición, clasificación , emergencias y urgencias hipertensivas, manejo y pronóstico.

hypertension is a syndrome characterized by persistent elevation of blood pressure. Its incidence in children in lower than in adults, it fluctuates from 1 to 3%. It may be primary or secondary, secondary hypertension is mostly causes by renal diseases. We describe the classification based on the fourth document of the National High Blood Pressure Education Program and also describe the auxillary methods for the diagnosis of the etiology. The treatment depends on the cause which could be pharmacological or no pharmacological ( Changes in life style, antihyperntensive urgencies and emergencies may be encountered in the emergency department. Efficent managment of these children is of utmost importance to avoid some of the life-threatening complications associated with hypertension and its treatment. The scop of this article is to review some of the important aspects of pediatric hypertension , including definition, classification, diagnosis, hypertensive urgencies and emergencies, managment and outcome.

Competência profissional: a construção de conceitos, estratégias desenvolvidas pelos serviços de saúde e implicações para a enfermagem / Professional competence: the construction of concepts, strategies developed by health services and implications for nursing / Competencia profesional: la construcción de conceptos, estrategias desarrolladas por los servicios de salud y las implicaciones para la enfermería

Este estudo teve como objetivo identificar e analisar a produção científica sobre a temática de competência profissional, as estratégias das instituições de saúde para o seu desenvolvimento e implicações para enfermagem. Trata-se de revisão integrativa e a estratégia de busca foi a consulta às bases eletrônicas MEDLINE, LILACS e SciELO. A coleta foi realizada entre os meses de outubro a dezembro de 2010 e os artigos selecionados estão em português e inglês, totalizando 23 publicações. A análise temática dos dados possibilitou a construção de três categorias: Os significados do conceito de competência profissional; Estratégias para desenvolver a competência profissional; e Implicações para a enfermagem. Constatou-se a predominância do conceito de competência profissional a partir de seus elementos constitutivos, ou seja, de conhecimentos, habilidades e atitudes; estratégias educacionais e programas de treinamento para a formação de competências como ações da gerência; e na enfermagem, o desafio de formar profissionais competentes e compromissados.

This study aimed to identify and analyze the scientific literature on the topic of professional competence, strategies of health institutions for its development and implications for nursing. It is an integrative review and search strategy was consultation with the electronic databases MEDLINE, LILACS and SciELO. Data collection was conducted between October and December 2010 and selected articles in Portuguese and English, a total of 23 publications. The thematic analysis of the data enabled the construction of three categories: The meanings of the concept of professional competence, Strategies for development professional competence and Implications for nursing. It was verified the predominance of the concept of professional competence from their constituent elements, knowledge, skills and attitudes, strategies and educational training programs for skills training and actions of management, and nursing, the challenge of train professionals competent and committed.

Este estúdio tuvo como objetivo identificar y analizar la literatura científica sobre el tema de la competencia profesional, las estratégias de las instituciones de salud para su desarrollo y sus implicaciones para la enfermería. Se trata de uma revisión integradora y estrategia de búsqueda se consulta con las bases de datos electrónicas MEDLINE, LILACS y SciELO. La recolección de datos se realizó entre octubre y diciembre de 2010 y los artículos seleccionados están em Portugués e Inglés, con un total de 23 publicaciones. El análisis temático de los datos permitió la construcción de tres categorías: Los significados del concepto de competencia profesional, Estrategias para desarrollar la competencia profesional y Implicaciones para la enfermería. Se verificó el predominio del concepto de competencia profesional de sus elementos constitutivos, es decir, conocimientos, habilidades y actitudes, estrategias y programas educativos de formación para la capacitación y acciones de gestión y de enfermería, el desafío de la formación de profesionales competentes y comprometidos.

Avaliação de bebês portadores de fissura labiopalatina em relação à higiene oral / Evaluation babies with cleft lip and/or palate related to the oral hygiene

Avaliou-se a prevalência de cárie relacionada à ausência de higiene oral, em bebês portadores de fissura labiopalatina, na faixa etária entre 6 e 36 meses. As crianças eram atendidas no Ambulatório da Disciplina de Prótese Buco Maxilo Facial, do Depto. de Cirurgia, Prótese e Traumatologia Maxilo Faciais da FOUSP. Profilaxia prévia ao exame clínico foi realizada para aumentar a confiabilidade do diagnóstico de cárie, o qual foi obtido por meio da inspeção visual e tátil, sob iluminação artificial. Selecionou-se 143 crianças sem distinção de gênero, distribuídas em 5 faixas etárias: 06-12; 13-18; 19-24; 25-30 e 31-36 meses. A análise estatística utilizou o Teste Qui-quadrado, ajustado pela Estatística de Fisher. Ao ser analisada a ausência de higiene oral em relação à experiência de cárie, não se observou significância estatística (p=0,626). Quando se avaliou a prevalência de cárie frente ao aumento da idade e a ausência de higienização houve associação estatísticamente significante (p< 0,001). Concluiu-se que, para esta amostra, a ausência de higiene oral não foi fator de incremento na manifestação da cárie.

The study evaluated the caries prevalence related to the lack of oral hygiene in babies aged 6 to 36 months, with cleft lip and/or palate. Those children were treated in the Ambulatory of the Discipline of Bucco-Maxillo-Facial Prostheses, from the Department of Surgery, Prostheses and Maxillo-Facials Traumatology of the FOUSP. Before the clinical exam, prophylaxis was done to increase reliability of the visual and tactile inspection under artificial light. Were selected 143 children regardless of gender, distributed into 5 age groups: 06-12; 13-18; 19-24; 25-30 e 31-36 months old. The statistical analysis used the Q-Square-Test, adjusted by the Fischer’s Statistic. The analysis of the lack of oral hygiene correlated with the caries experience was not statistically significant (p=0,626). When the prevalence of caries was evaluated front to the increase of the age and the lack of oral hygiene, a statistical significant association was found (p< 0,001). The findings of the research didn’t show, in the sample, the lack of oral hygiene as a factor to increase the caries presence.

Indicadores de qualidade e a avaliação do gerenciamento de recursos humanos em saúde / Indicadores de calidad y la evaluación del gerenciamento de recursos humanos en salud / Quality indicators and evaluation of human resources management in health

Estudo qualitativo objetivando subsidiar a avaliação da qualidade do gerenciamento de recursos humanos (RH) em enfermagem e apreender como enfermeiros gerentes e docentes vivenciam o uso de indicadores de qualidade. Participaram 12 docentes, 10 gerentes, de quatro instituições de ensino e assistência, públicas e privadas do Município de São Paulo. A coleta deu-se de março a julho de 2007, por meio de entrevistas semi-estruturadas, gravadas e analisadas segundo referencial de análise temática. Dos achados emergiram duas categorias: Dimensão Institucional e Profissional; na primeira foram resgatadas percepções, sentimentos e demandas que as colaboradoras consideram inerentes à organização e que deveriam ser contrapartida na relação da instituição com os atores operativos. Na segunda, explicitaram os fatores intervenientes - motivos, interesses, disposições e necessidades dos profissionais no desempenho das atividades demandadas pela instituição. O estudo evidenciou o caráter processual da construção e validação de indicadores como ferramenta de gestão de qualidade em RH.

The aim of this qualitative study was to subsidize an evaluation of human resources management (HR) in nursing and to apprehend how the nursing managers and academic professors experience the use of quality indicators. Twelve academic professors, 10 managers from four teaching and assistance, public and private institutions in the city of São Paulo took part of this study. Data collection was carried out from March to July 2007, by means of semi-structured interviews, recorded and analyzed according to the thematic analysis referential. Two categories emerged from the results: Institutional and Professional Dimensions; in the first category, perceptions, feelings and demands that the collaborators found inherent to the organization and that could be the counterpart in the institution relationship with the operative actors were recovered. In the second category, they reported the intervenient factors - reasons, interests, disposition and professionals´ needs when performing activities required by the Institution. This study showed the processual character of construction and validation of indicators as a quality management instrument in HR.

Estudio cualitativo objetivando subsidiar la evaluación de la calidad del gerenciamento de recursos humanos (RH) en enfermería y aprehender como los enfermeros gerentes y docentes vivencian el uso de indicadores de calidad. En este estudio participaron12 docentes, 10 gerentes de cuatro instituciones de enseñanza y asistencia, públicas y privadas, del Municipio de São Paulo. La colecta se hizo de Marzo a Julio de 2007, a través de entrevistas semiestructuradas, grabadas y analizadas según referencial del análisis temático. De los hallazgos emergieron dos categorías: dimensión Institucional y Profesional; en la primera se rescataron percepciones, sentimientos y demandas que las colaboradoras consideraron inherentes a la organización y que deberían ser la contrapartida con relación a la institución con los actores operativos. En la segunda, explicitaron los factores intervinientes - motivos, intereses, disposiciones y necesidades de los profesionales en el desempeño de las actividades demandadas por la institución. Este estudio mostró el carácter procesual y validación de indicadores como una herramienta de gestión en calidad del RH.

A gestão da atividade do motorista de ônibus: um olhar ergológico / The activity management the bus driver: an ergological view

Este estudo busca colocar em evidência a atividade de gestão do trabalho efetuada pelo motorista de ônibus na cidade de João Pessoa/Pb, a partir do relato da atividade de um dia de trabalho deste profissional. Orientados pela perspectiva ergológica e fundamentados na ergonomia da atividade, verificamos que se intensifica a presença de variabilidades e instabilidades existentes em função do tipo de organização do trabalho adotado, o que eleva o nível de exigência dos usos de si por parte do motorista no modo de gestão. Face às im(previsibilidades) geradas pelo tempo, agruras do trânsito, relações com colegas, despachantes e passageiros, o motorista vivencia a dramática do trabalho ao gerir constantemente sua atividade, frente aos limites e equívocos da prescrição e às infidelidades do meio. No curso da atividade, a gestão operada pelo motorista se dá frente a diferentes e simultâneos fatores, muitas vezes antagônicos, como os resultados a alcançar - exemplificado pelo número mínimo de passageiros por viagem, o que nos remete à permanente pressão temporal a que está submetido -, e o respeito a valores não-dimensionados, como preservação da saúde e cordialidade na relação com os clientes. (AU)

This study adresses to evidenciate the work´s management activity accomplished by a bus driver in João Pessoa city, Paraíba, Brazil, starting from a labor day report of this professional. Guided by an ergological perspective and based on an ergonomic activity, it is verified that some presence of variabilities and existent instabilities is increasing due to the adopted work organization model, which enhances the demand level of usages by a bus driver on the management method. The driver, up to some un(predictabilities) generated by time such, trafic dificulties, collegues relationships, dispatchers and passengers, experiences the dramatic work by constantily managing his duty, also facing limits, tasks misunderstandings and infidelities in which his live in. In the activity course, the manegement accomplished by the driver occurs due to different and simultaneous factors, many times antagonistic, as the results to reach (exemplified by the minimum number of passengers by trip, prompting us to the permanent temporary pressure that is submitted), as well as the non-dimensional respectfulness values such health preservation and cordial relation with the customers. (AU)

Update in management of gestational diabetes mellitus / 대한주산의학회잡지

Women with gestational diabetes mellitus (GDM) are at increased risk for adverse outcome during pregnancy and the development of type 2 diabetes, cardiovascular disease, metabolic syndrome after pregnancy. Offspring of women with GDM are at increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood. For preventing complication, patients diagnosed with GDM should monitor their blood glucose level, physical activity, and undergo nutritional counseling for the purpose of maintaining normoglycemia, but not meeting glycemic goals with dietary changes alone should begin insulin therapy. After delivery, patients with prior gestational diabetes mellitus, especially history of obesity, hyperglycemia, insulin treatment during pregnancy, should be tested for diabetes annually. Offspring of women with GDM should be followed closely for the developing of obesity and impaired glucose tolerance.

Atualizações no tratamento do lúpus cutâneo / Updates in cutaneous lupus treatment

O lúpus cutâneo é a principal manifestação clínica do lúpus eritematoso sistêmico. Diferentes formas de apresentações clínicas e histopatológicas compõem o quadro cutâneo. A diferenciação de tais apresentações clínicas é de grande relevância para melhor abordagem terapêutica dos pacientes. Ampla variedade de intervenções terapêuticas está atualmente disponível para o tratamento do lúpus cutâneo. Nessa revisão, serão abordadas as principais opções terapêuticas, medicamentosas e não-medicamentosas, além das novas terapias ainda em estudo.

Cutaneous lupus is the most common systemic lupus erythematosus clinical manifestation. Skin lesions are classified according to the clinical and histopathologic features, which are of great relevancy for the management of the disease. Nowadays several therapeutic interventions are available to the treatment of cutaneous lupus. In this review we will approach the most widely used and also the new therapies which are under study.

A trajetória da produção científica do Curso de Especialização em Gerenciamento de Serviços de Enfermagem da UNIFESP / La trayectoria de la producción cientifica del Programa de Post Grado en Gerenciamento de Servicios de Enfermería de la Universidad Federal de São Paulo / Scientific production trajectory of the São Paulo Federal University Post-Graduate Program in Nursing Services Management

Este artigo descreve a trajetória da produção científica do Curso de Gerenciamento de Serviços de Enfermagem da UNIFESP a partir da análise das monografias produzidas pelos alunos nos dez anos de existência do curso. Com o objetivo de Identificar temas e objetivos e desenhar linhas de pesquisa a que corresponderam esses trabalhos, 113 monografias foram estudadas. A apuração de freqüência simples e relativa das variáveis estudadas e a classificação da temática segundo referencial teórico sobre o assunto indicou que, no início, os estudos não se atinham à área de abrangência do curso, mas paulatinamente foram se orientando para esta, com destaque para " Recursos Humanos" , o que se acelerou com a criação de grupo de pesquisa focado na sub-especialidade " Gerenciamento em Enfermagem".

This article describes the scientific production trajectory of the Post-Graduate Program in Nursing Services Mangement at São Paulo Federal University based on the analysis of monographies produced by the students over the last 10 years. The study aimed at identifying subjects and objectives and to delineate research lines of these studies, 113 monographs were analyzed. The verification of the simple and relative frequency of the studied variables and the thematic classification according to the theoretical referential on this subject showed that at the beginning the studies did not considered the area of course extent but gradually they began to reach it with emphasis in " Human Resources" , which was accelerated with the establishment of a research group with the focus in the sub-specialty " nursing management".

Este artículo describe la trayectoria de la producción científica del curso de Administración de Servicios de Enfermería de la UNIFESP a partir del análisis de las monografías producidas por los alumnos en los diez años de existencia del curso. Con el objetivo de identificar los temas y objetivos y delinear líneas de pesquisa referentes a esos trabajos, 113 monografías fueron estudiadas. La apuración de frecuencia simple y relativa de las variables estudiadas y la clasificación de temática según el referencial teórico sobre el asunto indicó que, al inicio, los estudios no se restringieron al área de abarcamiento del curso pero paulatinamente, fueron se orientando hacia esta, con destaque para " Recursos Humanos" , lo que se aceleró con la institución del grupo de pesquisa con foco en la subespecialidad " Administración en Enfermería".

Tendencias neoliberales en la reforma de la gestión pública en América Latina / Neoliberals tendencies in the public gestation reform in Latin America

Se discuten las tendencias de reforma de la administración pública en América Latina, vigentes incluso en algunas regiones de Venezuela, a pesar del avance del proyecto bolivariano neoestatista con aspiraciones revolucionarias. La metodología responde a una revisión bibliográfica con algunas referencias a experiencias concretas de los sistemas de salud. Las tendencias neoliberales identificadas se expresan en: descentralización como fase previa al desarrollo de medidas mas radicales; privatización explícita e implícita; flexibilidad organizacional y cambios en el control; modernización de los sistemas de información; contratación y remuneración laboral flexibles; organización centrada en el cliente; desarrollo institucional y cambio en la cultura organizacional y ciudadana; financiamiento según la demanda en sustitución del financiamiento a la oferta de servicios. Se concluye que el eje fundamental de la reforma se expresa en distintos mecanismos privatizadores. Las líneas futuras de investigación se centrarán en el análisis empírico de la experiencia venezolana en gestión de la salud.

There are discussed the trends of reform of the public administration in Latin America, in force even in some regions of Venezuela, in spite of the advance of the project bolivariano neoestatista with revolutionary aspirations. The methodology responds to a bibliographical review with somereferences to concrete experiences of the systems of health. Those tendencies are expressed in: decentralization as a previous phase to the development of more radical measures; explicit and implicit privatization; organizational flexibility and changes in the control; modernization of the information systems; hiring and flexible labor remuneration; customer-centeredorganization; institutional development and change in the organizational and citizen culture; and financing according to the demand in substitution of the offer financing. It is concludedthat the fundamental axis of the reform is expressed in different privatizing mechanisms. The future lines of research will centre on the empirical analysis of the Venezuelan experience inmanagement of the health.

Comportamiento de la morbimortalidad y manejo de riesgo en población afectada por un evento sísmico / Behaviour of morbimortality and risk management in a population affected by an earthquake

Después del terremoto del Eje Cafetero colombiano, el Ministerio de Salud Pública diseñó una estrategia de saneamiento ambiental que definió los lineamientos de trabajo a nivel departamental y municipal basados en la vigilancia y control de factores medioambientales. El objetivo del presente trabajo fue evaluar el manejo del riesgo de enfermedades asociadas al saneamiento ambiental en el municipio de Calarcá, Departamento del Quindío, para lo cual se realizó un estudio epidemiológico descriptivo. El universo estuvo constituido por la totalidad de asentamientos temporales establecidos en ese sitio. Se utilizaron los registros de la Oficina de Epidemiología de la Secretaría de Salud y de las principales unidades notificadoras durante los meses de marzo a diciembre de 1999. Se analizaron, además, los resultados de la vigilancia centinela para el monitoreo de agentes etiológicos de enfermedad diarreica aguda (EDA), infección respiratoria aguda (IRA), hepatitis y contaminantes del agua. Se estableció la vigilancia de V. cholerae, Salmonella sp. y Shigella. Los datos se introdujeron y procesaron en el programa EPI-Info versión 6.2, y para el análisis se utilizaron medidas de frecuencia absoluta y relativa de las variables estudiadas. Los resultados demuestran que el aumento de la mortalidad fue causa directa del sismo. Las infecciones respiratorias y diarreicas agudas y las enfermedades de la piel constituyeron las principales causas de morbilidad. Se identificó una disminución de las tasas de enfermedades diarreicas agudas asociadas a la mejoría de las condiciones de saneamiento ambiental. Las infecciones respiratorias agudas solo mostraron un ligero descenso al persistir el hacinamiento y las malas condiciones estructurales de las viviendas.

After the earthquake that took place in the Colombian coffee belt, the Ministry of Public Health drew an environmental sanitation strategy that defined the working guidelines at department and municipal levels, on the basis of surveillance and control of environmental factors. The objective of the present paper was to evaluate the management and environemntal sanitation-associated disease risks in Calarcá municipality, Quindio District, through an epidemiological and descriptive study. The universe of this study was the total number of temporary settlements in this municipality. The records of the Epidemilogical Office of the Health Department and those of the main disease notification units were used from March to December 1999. Additionally, the results of the monitoring of etiological agents causing acute diarrheal diseases, acute respiratory infection, hepatitis and water pollution were analyzed. V.cholerae, Salmonella sp and Shigella were closely surveilled. Epi-Info version 6.2 program made it posible to input and process relevant data whereas absolute and relative frequency measures of the studied variables facilitated the analysis. The outcomes showed that increase in mortality was the direct consequence of earthquake. Respiratory infections, acute diarrheas and skin diseases were the main causes of morbidity. A reduction in acute diarrheal disease rates related to improved environmental conditions was observed. Acute respiratory infections showed just a slight decline since crowding and deficient structural conditions of housing persisted.

Observação e diário de campo: técnicas utilizadas no estágio da disciplina administração de enfermagem / Observations and field diaries: techniques used during internships in nursing management courses / Observación y diario de campo: técnicas utilizadas en la práctica profesional de la asignatura administración en enfermería

Este trabalho objetivou analisar a experiência da utilização das técnicas e do diário de campo no estágio da disciplina Administração em Enfermagem I e Deontologia, ministrada no curso de graduação em Enfermagem da Universidade Federal Minas Gerais, com alunos matriculados no quinto período. Para isso, realizamos um levantamento em 25 diários de campo, elaborados nos anos 2001 e 2002, buscando o significado atribuído pelos alunos às técnicas adotadas. Das narrativas emergiram 4 categorias, as quais evidenciaram que a estratégia utilizada possibilitou aos alunos uma reflexão sobre o exercício profissional de enfermagem, articulando a teoria e a prática, bem como oportunizou sua inserção nos serviços de saúde e facilitou a introdução em seu futuro ambiente de trabalho. Os docentes consideraram a adoção desta metodologia de ensino uma experiência ainda incipiente, mas que vem demonstrando sua viabilidade e adequabilidade para a construção de um pensamento crítico na enfermagem e para o alcance dos objetivos propostos no estágio.

This study aimed to analyze the experience of using observations and field diaries as internship techniques within the courses of Nursing Management I and Deontology. The courses were offered as part of the undergraduate Nursing program in the Federal University of Minas Gerais. The study focused on students registered in the fifth period. A survey of 25 field diaries, written in 2001 and 2002 was performed, searching for the meaning attributed by the students to the techniques adopted. From the narratives four categories emerged, which illustrated that the techniques utilized enabled the students to reflect about the professional exercise of nursing, articulating theory and practice. It also created an opportunity for their insertion within health services and facilitated an introduction to their future work atmosphere. The instructors considered the adoption of this teaching methodology a simple experience, but one which demonstrates its feasibility and adaptability in constructing a critical thought process in nursing, and reaching the objectives proposed within internships.

La finalidad de este trabajo fue analizar la experiencia de la utilización de las técnicas de observación y del diario de campo en la páctica profesional de la asignatura Administración en Enfermería I y Deontología en la Carrera de Pregrado en Enfermería de la Universidad Federal de Minas Gerais, con alumnos del quinto periodo. Para eso, realizamos una investigación en 25 diarios de campo elaborados en 2001 y 2002, buscando el significado atribuido por los alumnos acerca de las técnicas adoptadas. De las narrativas surgieron 04 categorías, que evidenciaron que la estrategia utilizada posibilitó a los alumnos reflexionar sobre la práctica profesional de enfermería, articulando teoría y práctica, y también ha permitido su inserción en los servicios de salud, facilitando la introducción en su futuro ambiente de trabajo. Los docentes consideraron da adopción de esta metodología de enseñanza una experiencia todavía incipiente, pero que está demostrando su viabilidad y adecuabilidad para la construcción de un pensamiento crítico en enfermería y para el alcance de los objetivos propuestos en la práctica profesional.

Diagnosis and surgical management of lumbar degenerative juxtafacet joint cysts / 中国矫形外科杂志

[Objective]To discuss the diagnosis and surgical management of lumbar degenerative juxtafacet joint cysts. [Methods]From June 2004 to June 2007,seven patients were diagnosed as degenerative juxtafacet joint cysts and were treated by surgery. The authors made a retrospective analysis on the clinical data of these 7 patients. Among these 7 patients,there were one as ligamentum flavum cyst and six as facet joint cysts. Five lesions were located at the L4、5 level and two were located at the L5S1 level. According to the preoperative lateral films and CT scan,segment instability were found in two patients. Fenestration decompression,resection of cyst and 1/3 medial articular process were performed on five patient without preoperative segment instability,while additional posterior fixation and posterolateral fusion were done to two patients with preoperative segment instability.The mean length of follow up were 14 months (range: 9~24 months ). The VAS score and ODI score were used for clinical outcome assessment.[Results]The pathological results confirmed the preoperative radiological diagnosis in all patients. Improvement were found in all patients,including completely recovery in five patients and significant relief of pain in other two patients.[Conclusion]Lumbar degenerative juxtafacet joint cysts has been proved to be a cause of low back pain. Preoperative CT scan and MRI are helpful in the diagnosis and the clinical outcome of surgery is satisfactory.