Modelos de agendamento e o acesso a imunização na atenção primária a saúde / Appointment models and access to immunization in primary health care / Modelos de cita y acceso a inmunización en atención primaria de salud

A Atenção Primária à Saúde é caracterizada como a porta de entrada preferencial do sistema de saúde com território adscrito. Desta forma, deve prover ações de promoção, prevenção e reabilitação da saúde. Sendo assim, a escassez de investigações sobre o acesso à saúde e a imunização levanta questões sobre como os modelos de agendamento impactam a disponibilidade e a acessibilidade das vacinas. Trata-se de um estudo reflexivo conduzido no período de junho a agosto de 2023. O estudo tem como base a análise discursiva das orientações do Ministério da Saúde, assim como a aceitabilidade, satisfação e, consequentemente, adesão à vacinação por parte dos usuários. A pesquisa originou-se a partir das provocações e debates realizados pelo Grupo de Pesquisa "Abordagens Tecnológicas no Cuidado à Saúde e Promoção da Saúde" da Escola de Enfermagem da Universidade de São Paulo (EEUSP). Está dividido em três seções que abordam os principais pontos de reflexão. O estudo considerou que é notável que a maneira como o usuário é recebido e tratado pelo sistema influencia diretamente a aceitabilidade, satisfação e, consequentemente, adesão à vacinação. Portanto, ao escolher e planejar o método de agendamento do serviço de saúde, as particularidades da área de vacinação devem ser consideradas, contemplando a demanda espontânea e a abordagem e controle do usuário.

Primary Health Care is characterized as the preferred gateway to the health system with an assigned territory. In this way, it must provide health promotion, prevention and rehabilitation actions. Therefore, the scarcity of research on access to healthcare and immunization raises questions about how scheduling models impact the availability and accessibility of vaccines. This is a reflective study conducted from June to August 2023. The study is based on the discursive analysis of the Ministry of Health's guidelines, as well as the acceptability, satisfaction and, consequently, adherence to vaccination by users. The research originated from the provocations and debates carried out by the Research Group "Technological Approaches in Health Care and Health Promotion" at the School of Nursing of the University of São Paulo (EEUSP). It is divided into three sections that address the main points of reflection. The study considered that it is notable that the way the user is received and treated by the system directly influences acceptability, satisfaction and, consequently, adherence to vaccination. Therefore, when choosing and planning the health service scheduling method, the particularities of the vaccination area must be considered, considering spontaneous demand and user approach and control.

La Atención Primaria de Salud se caracteriza por ser la puerta de entrada preferente al sistema de salud con un territorio asignado. De esta manera, debe brindar acciones de promoción, prevención y rehabilitación de la salud. Por lo tanto, la escasez de investigaciones sobre el acceso a la atención sanitaria y la inmunización plantea interrogantes sobre cómo los modelos de programación afectan la disponibilidad y accesibilidad de las vacunas. Se trata de un estudio reflexivo realizado de junio a agosto de 2023. El estudio se basa en el análisis discursivo de las directrices del Ministerio de Salud, así como de la aceptabilidad, satisfacción y, en consecuencia, adherencia a la vacunación por parte de los usuarios. La investigación surgió de las provocaciones y debates realizados por el Grupo de Investigación "Enfoques Tecnológicos en Atención y Promoción de la Salud" de la Escuela de Enfermería de la Universidad de São Paulo (EEUSP). Se divide en tres apartados que abordan los principales puntos de reflexión. El estudio consideró que se destaca que la forma en que el usuario es recibido y tratado por el sistema influye directamente en la aceptabilidad, satisfacción y, en consecuencia, en la adherencia a la vacunación. Por lo tanto, en la elección y planificación del método de programación de los servicios de salud se deben considerar las particularidades del área de vacunación, considerando la demanda espontánea y el abordaje y control de los usuarios.

Cirugía en horario extendido: una visión de los actores involucrados / Extended hours surgery: a vision of the actors involved

Introducción. Las listas de espera para cirugía de alta prevalencia son producto de una limitada oferta ante una elevada demanda de jornadas quirúrgicas. Tienen un impacto sobre las condiciones médicas de los pacientes y la consulta por urgencias. Como respuesta, se han incorporado los espacios quirúrgicos adicionales en horarios no convencionales. Su creciente implementación, aunque controversial, se reconoce cada vez más como una nueva normalidad en cirugía. Hay una limitada documentación de la efectividad de la medida, debido a la complejidad e intereses de los participantes. Métodos. Se analizó desde una posición crítica y reflexiva la perspectiva de los actores involucrados en un programa de cirugía en horario extendido, estableciendo las posibles barreras y los elementos facilitadores de una política enfocada a procedimientos en horario no convencional. Asimismo, se describen posibles oportunidades de investigación en el tema. Discusión. Los programas quirúrgicos en horarios no convencionales implican un análisis de los determinantes de su factibilidad y éxito para establecer la pertinencia de su implementación. La disponibilidad de las salas de cirugía, una estandarización de los procedimientos y una cultura de seguridad institucional implementada por la normativa vigente, favorecen estas acciones operacionales. Los aspectos económicos del prestador y del asegurador inciden en la planeación y ejecución de esta modalidad de trabajo. Conclusión. La realización segura y el éxito de un programa de cirugía en horario no convencional dependen de la posibilidad de alinear los intereses de los actores participantes en el proceso

Introduction. Waiting lists for high-prevalence surgeries are the product of limited supply due to a high demand for surgical days. They have an impact on patients' medical conditions and emergency consultation. In response, additional surgical spaces have been incorporated at unconventional times. Its growing implementation, although controversial, is increasingly recognized as a new normal in surgery. There is limited documentation of the effectiveness of the measure due to the complexity and interests of the participants. Methods. The perspective of the actors involved in an extended hours surgery program was analyzed from a critical and reflective position, establishing the possible barriers, and facilitating elements of a policy focused on procedures during unconventional hours. Possible research opportunities on the topic are also described. Discussion. Surgical programs at unconventional times involve an analysis of the determinants of their feasibility and success to establish the relevance of implementation. The availability of operating rooms, a standardization of procedures and a culture of institutional security implemented by current regulations, favor these operational actions. The economic aspects of the provider and the insurer affect the planning and execution of this type of work. Conclusion. The safe realization and success of a surgical program in unconventional hours depend on the possibility of aligning the interests of the actors involved in the process

Tecnologias de gestão para agendamento cirúrgico: revisão integrativa / Management technologies for surgical scheduling: integrative review / Tecnologías de gestión para el programa quirúrgico: examen integrativo

Objetivo: Analisar quais tecnologias de gestão são utilizadas no processo de agendamento de cirurgias. Método: Revisão integrativa da literatura realizada nas bases de dados ACM, IEEE, Taylor & Francis, CINAHL, LILACS, Medline via PubMed, Scopus e Web of Science. As referências identificadas foram exportadas para o gerenciador EndNote e, em seguida, para o aplicativo web Rayyan para a seleção dos estudos. As etapas de amostragem, categorização dos estudos, avaliação dos estudos incluídos, interpretação dos resultados e síntese do conhecimento foram realizadas por dois revisores de forma independente e mascarada. Resultados: dos 822 artigos identificados, 38 foram selecionados para compor a presente revisão. Sobre categoria profissional dos autores 81,6% são de ciências exatas, 13,1% da área da saúde e 5,3% multiprofissional. A tecnologia de gestão mais utilizada foi de programação linear inteira mista. Conclusão: Houve grande diversidades de tecnologias de gestão para agendamento de cirurgias que visam a maximização do uso da sala de operação, redução de fila de espera, redução dos custos e melhoria nos indicadores de qualidade.

Objective: To analyze which management technologies are used in the surgery scheduling process. Method: Integrative literature review carried out in the ACM, IEEE, Taylor & Francis, CINAHL, LILACS, Medline via PubMed, Scopus, and Web of Science databases. The identified references were exported to the EndNote manager and then to the Rayyan web application for the selection of studies. The steps of sampling, categorization of studies, evaluation of included studies, interpretation of results and synthesis of knowledge were performed by two reviewers independently and independently and blindly. Results: Out the 822 articles identified, 38 were selected to compose the present review. Regarding the professional category of the authors, 81,6% are from the exact sciences, 13,1% from the health area and 5,3% from the multidisciplinary field. The most used management technology was mixed integer linear programming Conclusion: There was a great diversity of management technologies for scheduling surgeries aimed at maximizing the use of the operating room, reducing the waiting list, reducing costs, and improving quality indicators.

Objetivo: Revisar qué tecnologías de gestión se utilizan en el proceso de programación quirúrgica. Método: Revisión integral de la literatura en bases de datos ACM, IEEE, Taylor & Francis, CINAHL, LILACS, Medline a través de PubMed, Scopus y Web of Science. Las referencias identificadas se exportaron al gerente de EndNote y luego a la aplicación web Rayyan para la selección de estudios. Los pasos de muestreo, la categorización de los estudios, la evaluación de los estudios incluidos, la interpretación de los resultados y la síntesis de los conocimientos fueron realizados por dos examinadores de manera independiente y encubierta. Resultados: De los 822 artículos identificados, se seleccionaron 38 para realizar esta revisión. En cuanto a la categoría profesional de los autores, el 81,6% son de las ciencias exactas, el 13,1% del área de salud y el 5,3% multiprofesionales. La tecnología de gestión más utilizada fue la de programación lineal mixta. Conclusión: Había una amplia gama de tecnologías de gestión para programar cirugías con el fin de maximizar el uso de salas de operaciones, reducir las colas de espera, reducir los costos y mejorar los indicadores de calidad.

A percepção sobre o acesso avançado em uma unidade unidade-escola de atenção básica à saúde / Perception of advanced access in a basic health care unit

Resumo: Introdução: Uma das diretrizes da atenção básica à saúde (ABS) no Brasil é o primeiro contato da pessoa no sistema de saúde. O acesso ou a acessibilidade é um atributo essencial da APS que teve avaliação ruim em pesquisas brasileiras. O sistema de agendamento certamente influencia o acesso nas unidades de saúde, e o modelo por acesso avançado (AA) tem sido implantado no Brasil, e vem obtendo melhores resultados que modelos tradicionais de agendamento. Objetivo: Este estudo teve como objetivo compreender a percepção de profissionais que atuam em uma unidade básica de saúde de Uberlândia, em Minas Gerais - MG (Centro de Saúde Escola Jaraguá (Cejar)), sobre a implementação do AA. Método: Trata-se de um estudo qualitativo que utilizou o grupo focal e a análise de conteúdo. Resultado: Foram delimitadas as seguintes categoriais temáticas: Desafios desafios na consolidação da APS e investimento em equipes mínimas; Tensionamentos tensionamentos quanto ao aumento na demanda de atendimentos individuais e sobrecarga de trabalho; Educação educação e saúde: intersecções necessárias entre ensino, serviço, gestão e comunidade. Conclusão: O Cejar apresentou particularidades com a implementação do AA por ser uma unidade de ensino, por não ter Estratégia de Saúde da Família (ESF) consolidada e pela sobrecarga de trabalho advinda com dessa agenda, o que pode contribuir para o planejamento de outras equipes que tenham interesse pelo AA.

Abstract Introduction: One of the guidelines of Primary Health Care (PHC) in Brazil is the person's user's first contact with the health system. Access or accessibility is an essential attribute of PHC that has been poorly assessed in Brazilian surveys. The appointment scheduling system certainly influences access in health units, and the model for advanced access (AA) has been implemented in Brazil, and has been achievinggetting better results than traditional scheduling models. Objective: The objective of the presentthis study is to understand the perception of professionals who work in a basic health unit in Uberlândia-MG (Centro de Saúde Escola Jaraguá) about the implementation of AA. Method: It is a qualitative study that used the focus group methodology and content analysis. Result: The following thematic categories were delimited: Challenges in the consolidation of PHC and investment in minimal teams; Tensions regarding the increasedin the demand for individual careassistance and work overload; Education and health: necessary intersections between teaching, service, management and community. Conclusion: It was concluded that CEJAR presented specific characteristicsparticularities with the implementation of AA as it isfor being a teaching unit, doesfor not haveing a consolidated Family Health Strategy (FHS) and due to thefor the work overload resulting from this scheduleagenda, which can contribute to the planning of other teams that are interested in AA.

Study on nurses scheduling based on multi-objective integer programming model in COVID-19 pandemic / 中华医院管理杂志

Objective:To establish a scientific and reasonable nurse scheduling model for ward nursing during COVID-19, to achieve collaborative and efficient scheduling of manpower and materials, and to provide an algorithm basis for the computerized scheduling as well as references for optimizing manpower scheduling in public health emergencies.Methods:The qualitative interview method was used to learn the challenges in nursing manpower scheduling at designated hospitals. In view of the nursing scheduling in the mild case wards during the pandemic and the premise of meeting the needs of different shift types and patient care, the goal was set as minimizing the consumption of nursing human resources and protective equipments. The objective functions, constraints and corresponding parameters were established. A multi-objective integer programming model was established by MATLAB software for solution by CPLEX solver.Results:Two objective functions, three hard constraints, two soft constraints and corresponding parameters were established. Calculations by the model so established found that a 28-day period requires at least 62 nurses, and at least 52 nurses in the contaminated wards, including 7 nurses in the department of intensive care, the infectious and the respiratory wards respectively. This number could meet in general the needs of epidemic care. In comparison, the manual scheduling of the mild care wards during the pandemic in February 2020 needed at least 69 nurses, and 61 in the contaminated wards, yet with a failure to meet all constraints.Conclusions:The model can solve the scheduling challenges in public health emergencies, namely numerous shift types, different nursing needs in different types of shifts, and complex staff structure.Furthermore, the model can save manpower and materials, serving a useful reference for manpower scheduling.

Uso de aplicativos digitais móveis e sua integração em cirurgia plástica / Use of digital mobile applications and their integration in plastic surgery

Introdução: No ambiente de novas tecnologias digitais em saúde, muitos paradigmas estão sendo rompidos e a abertura para obter novos conhecimentos permite ao cirurgião plástico usá-las na sua prática profissional. O presente artigo propõese a analisar a utilização de aplicativos digitais móveis, por pacientes e profissionais, visando entender a importância e o reconhecimento desse tipo de tecnologia no sentido de proporcionar maior qualidade e segurança nos atendimentos médicos, especificamente para atendimentos eletivos da especialidade cirurgia plástica. Métodos: Foram realizadas duas análises, em paralelo, de maneira retrospectiva e descritiva: 1) das conversas realizadas através de um aplicativo móvel de mensagens instantâneas no canal de comunicação destinado ao acompanhamento de pacientes submetidos a cirurgias em uma clínica privada de cirurgia plástica; (2) da utilização de tecnologias digitais em cirurgia plástica, através da análise das respostas de um questionário de pesquisa enviado aos profissionais dessa especialidade. Resultados: Na amostra obtida (n=61), registrou-se a média mensal de 122 conversas no pós-operatório. Em pesquisa de satisfação, os pacientes consideraram útil ter um meio de comunicação através de aplicativo de celular diretamente com a clínica. Somente 4,1% dos profissionais que participaram da pesquisa dispunham de um aplicativo próprio da sua clínica. Conclusão: A percepção da importância da tecnologia na assistência dos pacientes, a necessidade de atender os requerimentos da população e a possibilidade de proporcionar um acompanhamento mais abrangente, de forma confiável, fornecem embasamento para validar novos recursos de tecnologia, aplicativos móveis com recursos específicos no atendimento de cirurgia plástica.

Introduction: In the environment of new digital health technologies, many paradigms are being broken, and the opening to obtain further knowledge allows the plastic surgeon to use them in their professional practice. This article aims to analyze the use of digital mobile applications by patients and professionals. The purpose is to understand the importance and recognition of this type of technology to provide more quality and safety in medical care, specifically for elective care in the plastic surgery specialty. Methods: Two analysis were carried out, in parallel, in a retrospective and descriptive manner: 1) of the conversations carried out through a mobile instant messaging application on the communication channel for monitoring patients undergoing surgery in a private plastic surgery clinic; (2) of the use of digital technologies in plastic surgery, through the analysis of the responses to a research questionnaire sent to professionals in this specialty. Results: In the sample obtained (n = 61), the monthly average of 122 conversations in the postoperative period was recorded. In a satisfaction survey, patients found it useful to communicate through a mobile application directly with the clinic. Only 4.1% of the professionals who participated in the research had their own clinic application. Conclusion: The perception of the importance of technology in patient care, the need to meet the population's requirements, and the possibility of providing more comprehensive monitoring reliably offer the basis for validating new technology resources and mobile applications with specific resources in plastic surgery care.

A educação permanente em saúde como estratégia para otimizar o sistema de regulação no município de Itaperuna-RJ / Permanent health education as a strategy to optimize the regulatory system in the municipality of Itaperuna-RJ

O presente estudo, tem como objeto de estudo a Educação Permanente em Saúde como estratégia para reorganização de um serviço de especialidades na região noroeste fluminense do Estado do Rio de Janeiro. Tem-se por objetivo geral elaborar um fluxograma para reorganizar o serviço de agendamento / marcação de consultas especializadas no nível secundário de atenção à saúde; e os objetivos específicos, descrever o funcionamento atual do serviço de agendamento / marcação de consultas para especialidades médicas e de outros profissionais na atenção secundária; identificar o conhecimento dos profissionais envolvidos quanto ao processo de organização do sistema de regulação de consultas especializadas; registrar até que ponto / ou de que modo o conhecimento dos profissionais sobre integralidade interfere no processo de organização do serviço de marcação de consultas para especialidades; refletir como a Educação Permanente em Saúde pode contribuir para a reorganização de um serviço de especialidades na região noroeste fluminense, visando fortalecer a integralidade do acesso à saúde. Metodologia: pesquisa de natureza descritiva, exploratória, com abordagem qualitativa e embasada nos fundamentos da pesquisa convergente assistencial. O estudo de campo foi realizado no Centro de Saúde Dr. Raul Travassos, no município de Itaperuna, Estado do Rio de Janeiro. A pesquisa, aprovada pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universidade Federal Fluminense e aprovada sob o nº 2.770.321, foi realizada em duas etapas. A primeira etapa estabeleceu um processo de observação, cuja intenção perpassou a necessidade de identificar como era o processo de marcação de consultas e com a aplicação de um questionário, e a segunda etapa com a realização de cinco oficinas, que tiveram as seguintes temáticas: 1. Olhar crítico: olhar a prática profissional e organizacional atual e repensar sobre os princípios do SUS com ênfase na integralidade do acesso; 2. Olhar construtivo: romper com a fragmentação da atenção através de uma nova forma de realizar o serviço. 3. Olhar expandido: pensar a forma de operacionalizar junto aos profissionais da rede de atenção à saúde e a população a reestruturação do serviço de saúde. 4. Olhar avaliativo: o grupo foi conduzido a reavaliar a proposta 5. Olhar político: através da exposição e debate do trabalho junto ao conselho municipal de saúde. Como produto, obtevese a implantação do Programa de Educação Permanente em Saúde no município de Itaperuna, a realização de oficinas de educação permanente em saúde, e a construção de um fluxograma para reorganização do sistema de regulação de consultas especializadas. Os resultados da observação participante, do questionário e dos grupos educativos, analisados segundo Bardin, referencial teórico de Paulo Freire e da Política Nacional de Educação Permanente em Saúde, emergiram em três categorias temáticas: Categoria 1. Aproximação da proposta do serviço, Categoria 2. Integralidade do acesso: da teoria à prática e Categoria 3. Problematização do fluxo de atendimento. Considerações finais: a identificação de problemas empíricos (filas em horários e ambientes desfavoráveis, tensões na relação entre profissionais e usuários do SUS, e exposições desnecessárias do serviço nas redes sociais), atrelada às questões advindas da revisão de literatura e as discussões nos grupos educativos, que apontaram a importância do princípio da integralidade como o direito ao acesso à saúde e a comunicação horizontal entre os diferentes pontos de atenção na rede, confirmaram que a Educação Permanente em Saúde, pode contribuir para implementar mudanças no processo de trabalho e fortalecer o princípio da integralidade do acesso em saúde.

The present study has as object of study the Permanent Health Education as a strategy for reorganization of a specialty service in the northwestern region of Rio de Janeiro State. The general objective is to develop a flowchart to reorganize the specialized appointment scheduling service at the secondary level of health care; and the specific objectives, describe the current operation of the appointment / appointment service for medical specialties and other professionals in secondary care; identify the knowledge of the professionals involved regarding the process of organization of the specialized consultation regulation system; record to what extent / or how knowledge of professionals about completeness interferes with the process of organizing the appointment consultation service for specialties; to reflect on how continuing health education can contribute to the reorganization of a specialty service in the northwestern region of the state, aiming to strengthen the integrality of access to health. Methodology: research of descriptive nature, exploratory, with qualitative approach and based on the foundations of convergent care research. The field study was conducted at the Dr. Raul Travassos Health Center, in the municipality of Itaperuna, State of Rio de Janeiro. The research, approved by the Research Ethics Committee of the Fluminense Federal University School of Medicine and approved under No. 2,770,321, was conducted in two stages. The first stage established an observation process, the intention of which was the need to identify what was the process of scheduling appointments and applying a questionnaire, and the second stage with five workshops, which had the following themes: 1. Critical look: look at current professional and organizational practice and rethink the principles of SUS with emphasis on integrality of access; 2. Constructive look: break with the fragmentation of attention through a new way of doing the service. 3. Expanded look: think about how to restructure health care professionals and the population with the restructuring of the health service. 4. Evaluative look: the group was led to re-evaluate the proposal. 5. Political look: through exposure and discussion of the work with the municipal health council. As a product, the implementation of the Permanent Health Education Program in Itaperuna, the establishment of permanent health education workshops, and the construction of a flowchart for reorganization of the specialized consultation regulation system. The results of the participant observation, the questionnaire and the educational groups, analyzed according to Bardin, Paulo Freire's theoretical framework and the National Policy of Permanent Education in Health, emerged in three thematic categories: Category 1. Approximation of the service proposal, Category 2. Integrality of access: from theory to practice and Category 3. Problematization of the flow of care. Final considerations: the identification of empirical problems (queues at unfavorable times and environments, tensions in the relationship between SUS professionals and users, and unnecessary exposures of the service in social networks), linked to issues arising from the literature review and discussions in educational groups. , who pointed out the importance of the principle of comprehensiveness as the right to access to health and horizontal communication between the different points of attention in the network, confirmed that Permanent Health Education can contribute to implement changes in the work process and strengthen the principle. integrality of health access.

The application of nursing scheduling software combined with mobile phone APP in the nursing manpower arrangement in intensive care unit / 中国实用护理杂志

Objective@#To explore the effect of nursing scheduling software combined with mobile phone APP in the nursing manpower arrangement in intensive care unit.@*Methods@#The nursing scheduling software and mobile phone APP were applied to management resources of 82 nurses in ICU, substituted for traditional manual way. The work efficiency, nursing quality and nurse satisfaction were compared before and after implementing in intensive care unit.@*Results@#After implementation of nursing scheduling software combined with mobile phone APP, the average time of scheduling was reduced from (6.49±0.62) h to (4.29±0.44) h, the difference was statistically significant (t=19.97, P<0.01). The nursing quality score was improved from (97.54±1.19) points to (95.16±1.29) points, the difference was statistically significant (t=-4.70, P<0.01). The nurses′ satisfaction about scheduling was improved from 73.2%(60/82) to 96.3%(79/82), the difference was statistically significant (χ2=17.04, P<0.01).@*Conclusions@#The mode of nursing scheduling software combined with mobile phone APP in intensive care unit has a good effect, which can improve the scheduling efficiency, the job satisfaction of nursing staff and the quality of nursing,and promote the nursing information management.

Reference evapotranspiration estimated from air temperature using the MARS regression technique / Evapotranspiração de referência estimada a partir da temperatura do ar usando a técnica de regressão MARS

The reference evapotranspiration (ETo) is an important component for determining the water requirements of the crops. In order to estimate this variable accurately, the Food and Agriculture Organization (FAO) proposed the Penman-Monteith equation, however, this demands a large number of meteorological data, which restricts its use. In this context, this study compares the performance of the Penman-Monteith equation using only measured air temperature (PMT) and the Hargreaves-Samani (HS) equation with the performance of the multivariate adaptive regression splines (MARS) technique for the daily ETo estimation with only air temperature data. For the study, daily meteorological data from 2002 to 2016 were used. The data were collected from weather stations located in Florianópolis- SC, Manaus-AM and Petrolina-PE, being these selected in order to capture different climatic conditions. MARS models were developed for each weather station and the PMT e HS equations were locally calibrated. The performances of the original and calibrated equations and MARS models were evaluated based on the statistical indices root mean square error, mean absolute error, mean bias error and coefficient of determination. The ETo estimated by the Penman-Monteith method with full data was used as reference for the development of the MARS models, calibration of the equations and for the performance evaluation of the models under study. The calibration of the HS and PMT equations promoted better performances in relation to the original equations, improving the methods accuracy. The MARS technique presented good performance, outperforming the original and calibrated PMT and HS equations, with lower error values and higher coefficient of determination, and can be considered as an alternative to empirical methods.

A evapotranspiração de referência (ETo) é um componente importante para determinar o requerimento de água das culturas. Para estimar esta variável com acurácia, a Food and Agriculture Organization (FAO) propôs a equação de Penman-Monteith, no entanto, esta demanda um grande número de dados meteorológicos, o que restringe seu uso. Neste contexto, este estudo compara o desempenho da equação de Penman-Monteith usando apenas temperatura do ar medida (PMT) e a equação Hargreaves-Samani (HS) com o desempenho da técnica multivariate adaptive regression splines (MARS) para a estimativa da ETo diária com apenas dados de temperatura do ar. Para o estudo, foram utilizados dados meteorológicos diários de 2002 a 2016. Os dados foram coletados de estações meteorológicas localizadas em Florianópolis-SC, Manaus-AM e Petrolina-PE, sendo estas selecionadas a fim de capturar diferentes condições climáticas. Modelos MARS foram desenvolvidos para cada estação meteorológica e as equações de PMT e HS foram calibradas localmente. Os desempenhos das equações originais e calibradas e modelos MARS foram avaliados com base nos indicadores estatísticos raiz do erro quadrático médio, erro absoluto médio, viés médio e coeficiente de determinação. A ETo estimada pelo método de Penman-Monteith com dados completos foi utilizada como referência para o desenvolvimento dos modelos MARS, calibração das equações e para a avaliação da performance dos modelos em estudo. A calibração das equações HS e PMT promoveu melhores desempenhos em relação às equações originais, melhorando a acurácia dos métodos. A técnica MARS apresentou bom desempenho, superando as equações de PMT e HS originais e calibradas, com menores valores de erro e maiores coeficientes de determinação, e pode ser considerada como uma alternativa aos métodos empíricos.

Hyperbaric oxygen therapy can help restore neurological function after intracerebral hemorrhage / 中华物理医学与康复杂志

Objective To observe the effect of hyperbaric oxygen (HBO) therapy on neurological functioning in rats modelling cerebral hemorrhage (ICH).Methods Sixty Sprague-Dawley rats had intracerebral hemorrhage induced by injecting autologous blood.They were then randomly divided into an HBO-free group and an HBO group,each of 30 according to a random number table.The HBO group was further divided into HBO 3 h,HBO 6 h,HBO 1 d,HBO 2 d and HBO 7 d groups which received HBO therapy for 3 hours,6 hours,1 day,2 days and 7 days respectively.Each had 6 members.The HBO-free rats were also divided into analogous HBO-free 3 h,HBO-free 6 h,HBO-free 1 d,HBO-free 2 d and HBO-free 7 d groups,and give no HBO intervention.All of the rats were evaluated for neurological impairment using the Longa scoring method before the treatment and 10 days,20 days and 30 days afterward.Results After 10,20 and 30 days of HBO treatment,there were significant differences in neurological functioning between each pair of HBO-free and HBO-treated groups.After 10 and 20 days of HBO treatment the average neurological function score of the HBO 3 h group was significantly different from that of the HBO 2 d group.The average score in the HBO 7 d group was also significantly different from that of the HBO 3 h,HBO 6 h,HBO 1 d and HBO 2 d groups after 10,20 and 30 days of HBO treatment.The average scores of the HBO 3 h,HBO 6 h,HBO 1 d and HBO 2 d groups improved significantly between 10 and 20 days after the treatment.The average score of the rats which received 30 days of treatment was also significantly different from those after 10 and 20 days.Conclusion HBO treatment can improve neurological function after cerebral hemorrhage,at least in rats.The best time to start HBO treatment is no later than 24 hours after the hemorrhage.The curative effect increases with extension of the treatment's duration.

Design and application of intelligent surgical operation scheduling system / 中华护理杂志

Objective To develop an intelligent scheduling system for surgery by setting up constraints in an intelligent working environment to achieve automatic scheduling of surgery and personnel,and to precisely match the sub-professional nurses for surgeries.Methods Scheduling constraints were set up,and finally efficient scheduling was developed.Results During the process of clinical application,the rates of error and omission for surgical schedule fell to 4.78％,the rate of surgery re-adjustment fell to 17.74％,the number of average daily operation increased,the matching degree of sub-professional surgery nurse post reached 94.71％.Conclusion The intelligent surgical scheduling system can improve the scheduling efficiency and quality,improve the utilization of the operation rooms,and improve the collaboration quality and efficiency of the sub-professional nurses.

Modelo matemático para la planificación de servicios y programación de rutas en empresas prestadoras de servicios de control de plagas

Este artículo aborda el problema de la programación de servicios y planificación de rutas para empresas prestadoras de servicio de control de plagas (CP) considerando la minimización de los costos relacionados con las distancias recorridas por los vehículos usados y el costo del tiempo ocioso de los operarios. El problema considera actividades programadas, fechas de atención no disponibles, capacidad instalada, y datos de demanda previa obtenida de los clientes. La problemática consiste en la programación de los servicios y la planificación de las rutas de atención considerando ventanas de tiempo. En particular, se ha propuesto un modelo de programación lineal entera mixta, que busca mejorar la gestión logística de empresas que pertenecen a este sector. El modelo se ha probado con datos de una compañía colombiana que presta los servicios de CP en las principales ciudades colombianas. Los resultados obtenidos reflejan la importancia y eficiencia de la metodología propuesta como alternativa para la solución de la problemática en cuestión.

This paper addresses the problem of scheduling of services and planning of routes for companies which offer the service of pest control (CP) by considering the minimization of costs related to the distance traveled by the used vehicles and the cost of the cost of idle time of operators. The problem considers scheduled activities, dates not available and installed capacity, and data of demand previously provided by the customers. The problem consists of the scheduling and planning of the routes by considering time windows. In particular it is proposed a mixed integer linear programming model to improve the logistic management process of companies belonging to this sector The model has been tested with data obtained from a Colombian company that provides the CP services in the main Colombian cities. The results show the importance and efficiency of the proposed methodology as an alternative to the solution of the considered problem.

Este artigo discute o problema do agendamento de serviços e planejamento de rota para o controle de empresas de serviços de pragas (CP), considerando a minimização de custos relacionados com as distâncias percorridas pelos veículos usados e o custo do tempo ocioso de operadores . O problema considera actividades programadas, as datas não importa disponível, capacidade e dados de demanda obtidos a partir de clientes anteriores instalado. O problema é o de serviços de programação e cuidado planeamento da rota, considerando janelas de tempo. Em particular, ele propôs um modelo de programação linear inteira mista, que visa melhorar as empresas de gestão logística pertencentes a este sector. O modelo foi testado com dados de uma empresa colombiana, que fornece serviços de CP nas principais cidades colombianas. Os resultados mostram a importância e eficiência da metodologia proposta como uma alternativa para resolver o problema em questão.

Interações medicamentosas em pacientes com eventos cardiovasculares e suas implicações para a segurança do paciente / Drug interactions in patients with cardiovascular events and their implications for patient safety

O objeto deste estudo é as potenciais interações medicamentosas em prescrições de pacientes hospitalizados com eventos cardiovasculares e sua associação com a ocorrência de eventos adversos relacionados a medicamentos. Para atender tal objeto, foram estabelecidos como objetivos: identificar as potenciais interações medicamentosas em pacientes hospitalizados com eventos cardiovasculares, considerando os horários estabelecidos para administração de medicamentos pelo enfermeiro; avaliar a ocorrência de eventos adversos a medicamentos associados às potenciais interações medicamentosas graves identificadas; e discutir a segurança no uso dos medicamentos, em vista o agendamento de horários para a administração dos medicamentos realizado pelo enfermeiro. Pesquisa de campo, quantitativa, seccional, documental. Foram analisadas 99 prescrições medicamentosas relativas às primeiras 48 horas de internação, obtidas dos prontuários de pacientes hospitalizados no período de abril a junho de 2014 num setor de cardiologia de um hospital público federal. Utilizou-se um instrumento estruturado para a coleta de dados demográficos e clínicos no prontuário e levantamento das medicações nas prescrições, as quais foram submetidas em pares de acordo com o horário agendado para administração pelo enfermeiro para análise no software Micromedex quanto à ocorrência de potenciais interações medicamentosas. Foi aplicada nesta análise estatística descritiva, medidas de tendência central e dispersão e cálculo de razão de chance. Para a identificação dos eventos adversos, realizou-se a análise dos prontuários de pacientes que apresentaram interações medicamentosas classificadas como graves, com o emprego de rastreadores específicos para eventos adversos adaptados. Os pacientes em que estes rastreadores foram identificados tiveram seu caso discutido por painel de especialistas para a definição da ocorrência do evento adverso, com base no emprego de um instrumento- síntese do caso e aplicação do Algoritmo de Naranjo para a análise da causalidade. Os resultados evidenciaram a prevalência do sexo masculino na amostra dos pacientes hospitalizados, com média de idade de 71,7 anos e diagnóstico principal de Insuficiência Cardíaca. Sobre o agendamento de horários, houve predomínio das 06 horas. No serviço diurno, o horário prevalente foi às 18 horas e no serviço noturno às 06 horas. A frequência da ocorrência de potenciais interações medicamentosas graves foi de 38,59%, com maior destaque para os pares sinvastatina + anlodipino e enoxaparina + clopidogrel. O consenso de especialistas classificou três casos prováveis de ocorrência de evento adversos associados às PIM grave. Os danos observados foram relacionados a eventos hemorrágicos e implicaram no prolongamento do tempo de internação desses pacientes. Os resultados da pesquisa em tela reiteram a discussão contemporânea das políticas públicas nacionais e internacionais em torno do uso seguro dos medicamentos. Os achados reiteram a importância do papel do enfermeiro na vigilância do uso dos medicamentos e direcionam ao debate das possíveis intervenções para a melhoria da segurança medicamentosa institucional, tais como o uso de tecnologias como subsídio para a tomada de decisão, o emprego de treinamentos teórico-práticos baseados na simulação realística da prática cotidiana do cuidar; que devem funcionar como barreiras de segurança e promover a qualidade da assistência na clínica do cuidado de enfermagem.

The object of this study is the potential drug interactions in prescriptions of patients hospitalized with cardiovascular events and its association with the occurrence of adverse events related to medications. To meet this object, were established as objectives: to identify potential drug interactions in hospitalized patients with cardiovascular events, considering the schedules established for administering medications by nurse to evaluate the occurrence of adverse drug events associated with potential identified serious drugs interactions; and discuss the safety in the use of medications, in view of scheduling schedules for the administration of the medications performed by the nurse. To evaluate the occurrence of adverse drug events associated with potential identified serious drugs interactions; and discuss the safety in the use of medications, in view of scheduling schedules for the administration of the medications performed by the nurse. Field research, quantitative, sectional, documentary. We analyzed 99 drug prescriptions for the first 48 hours of hospitalization, obtained from the medical records of hospitalized patients in the period from April to June 2014 in a cardiology sector of a federal public hospital. A structured instrument was used to collect demographic and clinical data in the medical records and to survey the medications in the prescriptions which were submitted in pairs according to the scheduled time for administration by the nurse for analysis Micromedex software regarding the occurrence of potential drug interactions. It was applied in this descriptive statistical analysis measures of central tendency and dispersion and calculation of odds ratio. For the identification of adverse events, we performed the analysis of the medical records of patients who presented drug interactions classified as severe, with the use of specific trackers for adapted adverse events. The patients in which these trackers were identified had their case discussed by panel of experts to define the occurrence of the adverse event based on the use of an instrument-synthesis of the case and application of the Naranjo algorithm for causality analysis. The results evidenced the prevalence of males in the sample of hospitalized patients with a mean age of 71.7 years and a major diagnosis of heart failure. On scheduling times, there was a predominance of 6 hours. In the daytime service, the prevailing time was at 18 hours and at night service at 6 hours. The frequency of the occurrence of potential serious drug interactions was 38.59%, with greater emphasis on the Simvastatin + Amlodipine and Enoxaparin + Clopidogrel pairs. The consensus of specialists classified three probable cases of occurrence of adverse events associated with severe PIM. The observed damage was related to hemorrhagic events and implied the prolongation of hospitalization time of these patients. The results of the research on the screen reiterate the contemporary discussion of national and international public policies around the safe use of medications. The findings reiterate the importance of the role of the nurse in the surveillance of medication use and direct the discussion of possible interventions to improve the institutional drug safety, such as the use of technologies as a subsidy for the taking of decision, the use of theoretical-practical training based on the realistic simulation of the daily practice of care; That should function as safety barriers and promote the quality of care in the nursing care clinic.

A research for scheduling method of rehabilitation medical resource for smart traditional Chinese medicine based on genetic algorithm and its application on the treatment for dysphagia / 中国医学装备

Objective:To explore a scheduling method of rehabilitation medical resource for smart traditional Chinese medicine(TCM) for dysphagia because of cerebral apoplexy in order to save diagnosis time for patient and reasonably arrange treatment process for medical personnel.Methods: We designed the framework of smart TCM rehabilitation system, and proposed the medical resource scheduling model including acupuncture, massage and rehabilitation training. In addition, the genetic algorithm was employed to establish the scheduling method under the optimal objective towards the scheduling time.Results: (1) The treatment time of five dysphagia patients by using rehabilitation resource scheduling in Beijing Zhongguancun Hospital were saved 42.5% from the total treatment time compared to without scheduling; (2)The rehabilitation process of twenty virtual dysphagia patients were treated by the simulation scheduling, and 71% of total treatment time was saved. The efficiency of diagnosis and treatment was improved obviously .Conclusion: Smart TCM rehabilitation resource scheduling method can be used in an assisted rehabilitation therapy for dysphagia because of cerebral apoplexy, and it can improve the efficiency of diagnosis and treatment for patient and save a lot of medical resources.

Design and Application of Intelligent and Meticulous Nursing Scheduling Management System / 医学信息学杂志

The paper designs intelligent and meticulous nursing scheduling management system,introduces the system modules including basic information of personnel,scheduling of departments,attendance management,statistical analysis,etc.,and indicates that this system can be applied to reasonably allocate nursing resources and improve the management level of the nursing department.

Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey / 대한중환자의학회지

BACKGROUND: Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea. METHODS: An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS). RESULTS: Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues. CONCLUSIONS: Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist's role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.

Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey / 대한구급학회지

BACKGROUND: Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea. METHODS: An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS). RESULTS: Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues. CONCLUSIONS: Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist's role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.

Experience of nursing scheduling in the Ebola treatment center observation ward / 中国实用护理杂志

Objective To investigate the characteristics of the diagnosis and treatment center for Ebola observing ward and reduce infection risk according to allocation scheduling method of nursing staff. To provide reference for other similar tasks. Methods We used the method of grouping fixed group scheduling method and fixed working hours to identify and refine the content of nursing work. Results A total of 65 cases of suspected Ebola including 5 cases diagnosed as EVD patients were cured. No case of infection occurred in nursing staff. Conclusions During the infectious disease nursing work, reasonable personnel allocation and scheduling method can make the nursing staff work with full energy and strength and ensure the realization ofzero infectiontargets.

Research and Applications of Shop Scheduling Based on Genetic Algorithms

ABSTRACT Shop Scheduling is an important factor affecting the efficiency of production, efficient scheduling method and a research and application for optimization technology play an important role for manufacturing enterprises to improve production efficiency, reduce production costs and many other aspects. Existing studies have shown that improved genetic algorithm has solved the limitations that existed in the genetic algorithm, the objective function is able to meet customers' needs for shop scheduling, and the future research should focus on the combination of genetic algorithm with other optimized algorithms. In this paper, in order to overcome the shortcomings of early convergence of genetic algorithm and resolve local minimization problem in search process,aiming at mixed flow shop scheduling problem, an improved cyclic search genetic algorithm is put forward, and chromosome coding method and corresponding operation are given.The operation has the nature of inheriting the optimal individual ofthe previous generation and is able to avoid the emergence of local minimum, and cyclic and crossover operation and mutation operation can enhance the diversity of the population and then quickly get the optimal individual, and the effectiveness of the algorithm is validated. Experimental results show that the improved algorithm can well avoid the emergency of local minimum and is rapid in convergence.

Control de la variabilidad en la programación de pacientes electivos en salas de cirugía / Variability Control in the Scheduling of Elective Patients in Operating Rooms / Controle da variabilidade no agendamento de pacientes eletivos em salas de cirurgia

El Departamento de Cirugía genera una buena parte de los ingresos de un hospital. Este estudio evalúa la variabilidad en la programación de las cirugías y cómo esta atenta contra la eficiencia del servicio. Este estudio implemento un algoritmo para la generación de dos programaciones que luego fueron comparadas con la realizada manualmente en un hospital en Colombia. Las dos programaciones generadas se diferencian entre sí al incluir o no las máximas desviaciones en los tiempos de duración de las cirugías, asumiendo que estas son causadas por factores externas al proceso y pueden ser eliminadas. Los resultados muestran que al emplear un algoritmo automático para programar las cirugías, podrían mejorarse el tiempo de respuesta y la utilización de las salas. Aún más, se pudo concluir que la variabilidad asociada a la programación manual tiene un mayor impacto que la asociada a otros factores en los indicadores de desempeño del servicio.

The Surgery Department generates a sizeable amount of the income of a hospital. This study evaluates the variability in the scheduling of surgeries and how this threatens the efficiency of the service. This study uses an algorithm for the generation of two schedules that were later compared with a manually-generated schedule in a hospital in Colombia. The difference between the generated schedules is the inclusion or lack thereof of the maximum time deviations in surgery times, under the assumption that these are caused by external factors and may be eliminated. Results show that by using an automatic algorithm to schedule the surgeries response time and operating room use can be improved. Moreover, it can be concluded that the variability associated with manual scheduling has a greater impact than the one associated to other factors in the service performance indicators.

O Departamento de Cirurgia gera uma boa parte das rendas de um hospital. Este estudo avalia a variabilidade no agendamento das cirurgias e como ele atenta contra a eficiencia do servico. Este estudo implementou um algoritmo para a geração de dois agendamentos após comparados com aqueles realizados manualmente em um hospital na Colombia. Os dois agendamentos gerados diferenciam-se entre se por incluir ou nao os máximos afastamentos nos tempos de duração da cirurgia, assumindo que estes sao causados por fatores externos ao processo e podem ser eliminados. Os resultados mostram que usando um algoritmo automático para programar cirurgias, poderia se melhorar o tempo de resposta e a utilização das salas. Além disso, pode-se concluir que a variabilidade associada ao agendamento manual tem maior impacto que a associada a outros fatores nos indicadores de desempenho do servico.