Contribuições dos aplicativos móveis para o atendimento pré-hospitalar: revisão integrativa / Contribuciones de las aplicaciones móviles para la atención prehospitalaria: revisión integradora / Contributions of mobile applications to pre-hospital care: integrative review

Resumo Objetivo Analisar as contribuições científicas dos aplicativos móveis desenvolvidos para o atendimento pré-hospitalar. Métodos Estudo de revisão integrativa da literatura; as bases de dados usadas foram Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Biblioteca Digital Brasileira de Teses e Dissertações e ProQuest Dissertations & Theses Global; (período de 2017-2022), incluindo todas as categorias de artigo, (com resumo e textos completos, disponíveis com acesso gratuito) nos idiomas português, inglês ou espanhol, contendo as palavras-chave "Assistência Pré-Hospitalar", "Atendimento Pré-Hospitalar", "Serviços Pré-Hospitalares", "Atendimento de Emergência Pré-Hospitalar", "Enfermagem", "Aplicativos móveis", "Aplicativos de Software Portáteis", "Apps Móveis", nos títulos e/ou resumos. Dois pesquisadores aplicaram os critérios de elegibilidade dos estudos e coletaram os dados a partir do instrumento elaborado previamente. Resultados De um total de 944 estudos, 07 foram selecionados para avaliação. Os aplicativos móveis desenvolvidos para a área de atendimento pré-hospitalar são ferramentas tecnológicas que contribuíram para a triagem, primeiros socorros pediátricos, segurança do paciente, preparação de medicações durante parada cardíaca, qualidade da ressuscitação cardiopulmonar, comunicação entre equipe de emergência e registro eletrônico de enfermagem. Conclusão Os estudos apontaram as potencialidades referentes à utilização dos aplicativos móveis no atendimento pré-hospitalar, contribuindo especialmente para melhoria da segurança dos pacientes e a qualidade do cuidado prestado nas situações de urgência e emergência pré-hospitalar. A otimização do tempo de assistência e do diagnóstico precoce foram também mostrados como contribuições dos aplicativos na assistência, além de alertar para os detalhes que podem passar despercebidos.

Resumen Objetivo Analizar las contribuciones científicas de las aplicaciones móviles para la atención prehospitalaria. Métodos Estudio de revisión integradora de la literatura. Las bases de datos utilizadas fueron Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Biblioteca Digital Brasileira de Teses e Dissertações y ProQuest Dissertations & Theses Global (período de 2017-2022). Se incluyeron todas las categorías de artículos, con resumen y texto completo, disponibles con acceso gratuito, en los idiomas portugués, inglés o español, que contuvieran las palabras clave "Asistencia Prehospitalaria", "Atención Prehospitalaria", "Servicios Prehospitalarios", "Atención de Emergencia Prehospitalaria", "Enfermería", "Aplicaciones Móviles", "Aplicaciones de Software Portátiles", "Apps Móviles", en el título o resumen. Dos investigadores aplicaron los criterios de elegibilidad de los estudios y recopilaron los datos a partir de un instrumento elaborado previamente. Resultados De un total de 944 estudios, se seleccionaron siete para evaluación. Las aplicaciones móviles desarrolladas para el área de atención prehospitalaria son herramientas tecnológicas que contribuyeron para la clasificación, los primeros auxilios pediátricos, la seguridad del paciente, la preparación de medicaciones durante paro cardíaco, la calidad de la reanimación cardiopulmonar, la comunicación entre los equipos de emergencia y el registro electrónico de enfermería. Conclusión Los estudios señalaron el potencial referente a la utilización de las aplicaciones móviles en la atención prehospitalaria, lo que contribuye especialmente a la mejora de la seguridad del paciente y a la calidad del cuidado ofrecido en las situaciones de urgencia y emergencia prehospitalaria. La optimización del tiempo de la atención y el diagnóstico temprano también demostraron ser contribuciones de las aplicaciones de asistencia, además de advertir detalles que pueden pasar desapercibidos.

Abstract Objective Analyze the scientific contribution of mobile applications developed for pre-hospital care. Methods Integrative literature review study; the databases used were the following: Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Brazilian Digital Library of Theses and Dissertations, and ProQuest Dissertations & Theses Global; (period 2017-2022), including all article categories (with abstract and full texts available with free access) in Portuguese, English, or Spanish, containing the keywords "Pre-Hospital Assistance", "Pre-Hospital Care", "Pre-Hospital Services", "Pre-Hospital Emergency Care", "Nursing", "Mobile applications", "Portable Software Applications", and "Mobile Apps" in titles and/or abstracts. Two researchers applied the eligibility criteria of the studies and collected data using a previously prepared instrument. Results From a total of 944 studies, seven were selected for evaluation. Mobile applications developed for the pre-hospital care area are technological tools that have contributed to triage, pediatric first aid, patient safety, preparation of medications during cardiac arrest, quality of cardiopulmonary resuscitation, and communication between the emergency team and the electronic nursing record. Conclusions The studies highlighted the potential related to the use of mobile applications in pre-hospital care, contributing especially to improving patient safety and the quality of care provided in pre-hospital urgency and emergencies. The optimization of assistance and early diagnosis times was also shown as a contribution of applications to assistance, in addition to alerting to details that may be unnoticed.

Uso de TIC ́s para el manejo de enfermedades cardiovasculares / Use of ICTs for the managem ent of cardiovascular diseases

¿Son efectivas las aplicaciones móviles en las personas adultas con enfermedades cardiovasculares para mejorar su control? Como es sabido la población de edad más avanzada considera un obstáculo determinante el avance de la sociedad y su adaptación a los cambios que involucra, lo que refiere la importancia de buscar nuevas herramientas que le faciliten esa adaptación, aún más cuando su salud depende de ello cuando deben enfrentarse al control de enfermedades crónicas y de mucha atención. En este artículo se responderá esta interrogante mediante la revisión bibliográfica sistemática bajo estrategias de búsqueda en bases de datos reconocidas como Pubmed y Scielo de artículos previos enfocados al uso de TIC's en el control de enfermedades. Rescatando finalmente 6 artículos que muestran resultados positivos en la mejora del estado de salud y/o de la ad-herencia al tratamiento de los pacientes controlados en sus estudios, discutiendo factores que podrían mejorar sus resultados en estudios en los que no fueron significativos, valorando limitaciones y recomendaciones para estudios futuros, invitando finalmente a la población, a mejorar el estudio de la población adulta y adulta mayor, y a la búsqueda de herramientas que le permitan mejorar su salud, así como en el caso de las TIC'S que son una gran ayuda para mejorar el control de éstas, al comprobar que no generan ningún riesgo para quien las utiliza, no interfiere con la terapia tradicional farmacológica y solo refiere beneficios a pesar de las limitantes de accesibilidad que pueden ser fácilmente controladas[AU]

Are mobile applications effective in adults with cardiovascular diseases to improve their control? As is known, the older population considers the progress of society and its adaptation to the changes it involves to be a determining obstacle, which refers to the importance of seeking new tools that facilitate this adaptation, even more so when their health depends on This is when they have to face the control of chronic diseases and a lot of care. This article will answer this question through a systematic bibliographic review using search strategies in recognized databases such as Pubmed and Scielo of previous articles focused on the use of ICTs in disease control. Finally rescuing 6 articles that show positive results in improving the state of health and/or adherence to treatment of patients controlled in their studies, discussing factors that could improve their results in studies in which they were not significant, assessing limitations and recommendations for future studies, finally inviting the population to improve the study of the adult and elderly population, and to search for tools that allow them to improve their health, as well as in the case of ICTs that are a great help to improve the control of these, by verifying that they do not generate any risk for those who use them, does not interfere with traditional pharmacological therapy and only refers benefits despite the accessibility limitations that can be easily controlled[AU]

Os aplicativos móveis são eficazes em adultos com doenças cardio-vasculares para melhorar seu controle? Como se sabe, a população idosa considera o progresso da sociedade e sua adaptação às mu-danças que ela envolve um obstáculo determinante, o que remete à importância de buscar novas ferramentas que facilitem essa adap-tação, ainda mais quando sua saúde depende de quando têm que enfrentar o controle de doenças crônicas e muito cuidado. Este arti-go responderá a esta questão por meio de uma revisão bibliográfica sistemática utilizando estratégias de busca em bases de dados re-conhecidas como Pubmed e Scielo de artigos anteriores focados no uso das TICs no controle de doenças. Por fim resgatando 6 artigos que mostram resultados positivos na melhora do estado de saúde e/ou adesão ao tratamento dos pacientes controlados em seus estu-dos, discutindo fatores que poderiam melhorar seus resultados em estudos em que não foram significativos, avaliando limitações e re-comendações para estudos futuros, convidando finalmente a popu-lação a melhorar o estudo da população adulta e idosa, e a procurar ferramentas que lhes permitam melhorar a sua saúde, bem como no caso das TIC que são uma grande ajuda para melhorar o controlo destas, por verificando que não geram nenhum risco para quem os utiliza, não interferem na terapia farmacológica tradicional e ape-nas remetem a benefícios, apesar das limitações de acessibilidade facilmente controláveis[AU]

Scientific unknown-base in medical field: Supporting problem-oriented priority setting in basic research / 中华医学科研管理杂志

Objective:The present study delves into the realm of scientific unknowns, which serve as the primary representation of major scientific challenges and often give rise to subversive, non-consensus, and high-risk scientific problems. Addressing this pivotal aspect, we focus on the development of scientific unknown identification methods and tool platforms to provide essential data support for priority setting of basic research through a problem-oriented approach. Such efforts are imperative for managing the scientific and technological innovation system within the context of demands and problem-solving.Methods:While numerous knowledge bases have been established in the medical field, there remains a notable lack of focus on the unknown base. The paper synthesizes relevant literature and existing research, amalgamating the methodological paradigm of scientific big data research with text mining. This integration facilitates comprehensive interpretations and enlightening insights concerning the concept, identification methods, and construction of an unknown-base.Results:By systematically analyzing the concept of scientific unknowns, we present a recognition method based on cognitive state and logical rules. Furthermore, we discuss a classification framework and realization path for scientific unknowns from the dimensions of attribute, relationship, and disease, thereby providing foundational insights for the construction of a medical unknown database.Conclusions:Notably, the research on unknowns in medical science transcends disciplinary boundaries, encompassing the confluence of information science, data science, medical informatics, and science and technology management. As such, this paper seeks to expound upon the significance and application scenarios of unknown research in science, furnishing valuable ideas and references for scholars in the field.

Research on the Current Situation and Improvement Strategies of Science and Technology Ethics Management of Innovation Subjects Based on the Investigation of 11 Provinces (Autonomous Region, Cities) in China / 中国医学伦理学

The healthy development of science and technology (Sci. & Tech) innovation is inseparable from Sci. & Tech ethics. The innovation subject is the driving force of Sci. & Tech innovation. The improvement of Sci. & Tech ethical management ability is conducive to improving the China’s Sci. & Tech ethics governance system. Therefore, this paper deeply analyzed the current status of Sci. & Tech ethics management of the 76 innovation subjects from five aspects, and found that the construction of Sci. & Tech ethics management of Chinese innovation subjects has achieved initial results, but there was still room for further improvement. Based on the problems existing in the Sci. & Tech ethics management of innovation subjects, this paper proposed six strategic suggestions that strengthening the construction and research of artificial intelligence ethics management systems, establishing and improving ethics committees and management systems, actively implementing the registration of Sci. & Tech ethics management information, regularly organizing and participating in various forms of Sci. & Tech ethics training, attaching importance to the reserve and cultivation of composite Sci. & Tech ethics management talents, and cooperating to establish a Sci. & Tech ethics case library, with a view to enhancing the Sci. & Tech ethics management ability of Chinese innovation subjects to adapt to the needs of the healthy development of Sci. & Tech in China.

Aplicación de la Telemática en el monitoreo remoto de Bancos de Muestras Biológicas. Estudio Preliminar

Las serotecas son espacios destinados para el resguardo de Muestras Biológicas (MB) de procesos diagnósticos y científicos. El Instituto de Investigaciones en Ciencias de la Salud (IICS) cuenta con ocho congeladores de Ultra Baja Temperatura (UBT) distribuidos en dos serotecas. El sistema de monitoreo diseñado se evaluó durante cuatro meses, mientras registraba y enviaba alertas de tres UBT instalados en una de las serotecas y de su temperatura ambiente. Se recabó información de los usuarios respecto al rango de las temperaturas de cada UBT, tipo de MB almacenadas y su criterio de conservación. Se emplearon controladores de temperatura con sensores PT 100 conectados a un convertidor RS485/Ethernet en cada congelador. El sistema monitoreó, registró y alertó vía correo electrónico a los usuarios y técnicos biomédicos sobre los incidentes por temperaturas fuera del rango y falla de comunicación. En total se registraron 25 incidentes, 17 referentes al tiempo de apertura de puerta, 5 por temperatura elevada del ambiente y 3 por problemas en la conexión de red. La aplicación de la telemática fue determinante para monitorear en tiempo real las temperaturas de los congeladores UBT y del ambiente para garantizar que la cadena de frío no se vea afectada. De esta forma se cuenta con una herramienta que notifica a los usuarios de serotecas y biobancos los incidentes eléctricos o eventos que afecten el rango de temperatura necesario para la preservación de los materiales biológicos, permitiéndoles realizar una intervención oportuna y así garantizar la correcta preservación de las MB.

The serum banks are spaces used for the protection of Biological Samples (BS) of diagnostic and scientific processes. The Instituto de Investigaciones en Ciencias de la Salud (IICS) has eight Ultra Low Temperature (ULT) freezers distributed in two serum banks. The designed monitoring system was evaluated for four months, while recording and sending alerts of three ULTs installed in one of the serum banks and their ambient temperature. Information was collected from users regarding the temperature range of each ULT, type of stored BS and their conservation criteria. Temperature controllers with PT 100 sensors connected to an RS485/Ethernet converter were used in each freezer. The system monitored, recorded and alerted users and biomedical technicians via email about incidents due to temperatures outside the range and communication failure. In total, 25 incidents were recorded, 17 related to door opening time, 5 due to high ambient temperature and 3 due to network connection problems. The application of telematics was decisive in monitoring the temperatures of the ULT freezers and the environment in real time to ensure that the cold chain was not affected. In this way, there is a tool that notifies users of serum banks and biobanks of electrical incidents or events that affect the temperature range necessary for the preservation of biological materials, allowing them to perform a timely intervention and thus guaranteeing the correct preservation of the BS.

Uso de las plataformas tecnológicas para generar campañas exitosas de comunicación en salud / Use of technological platforms to generate successful health communication campaigns

Fundamento: el papel de las plataformas tecnológicas es radical en cualquier propuesta de comunicación en salud, máxime si va dirigida a estudiantes universitarios con el fin de generar campañas exitosas en la población. Objetivo: identificar los componentes teórico-metodológicos y prácticos que sustentan el uso de las nuevas tecnologías, desde su enfoque social, junto con los aportes específicos de las plataformas virtuales, para la implementación de una propuesta de comunicación en salud. Métodos: se realizó una investigación con enfoque cualitativo, en la Universidad Católica de Cuenca, carrera de Medicina durante septiembre 2021-marzo 2022. Se emplearon métodos teóricos y empíricos: entrevistas en profundidad, revisión documental y grupos focales. Resultados: se evidenció falta de conocimientos por los estudiantes de la carrera de Medicina sobre los modelos de comunicación y su implementación con el uso de nuevas tecnologías referentes a campañas preventivas de salud. Se identificaron los componentes teórico-metodológicos y prácticos que sustentan el uso de las nuevas tecnologías, junto con los aportes específicos de las plataformas virtuales para la implementación de una propuesta de comunicación en salud sobre promoción de estilos de vida saludables y prevención de enfermedades, la cual fue valorada por criterios de expertos. Conclusiones: el producto diseñado resultó adecuado: proporcionó que los docentes, estudiantes médicos, futuros profesionales y funcionarios de la salud estén mejor preparados para comunicar, de forma efectiva, campañas de prevención y cuidado en salud, en disímiles contextos más allá del entorno nacional.

Background: the role of technological platforms is radical in any health communication proposal, especially if it is aimed at university students in order to generate successful campaigns in the population. Objective: to identify the theoretical-methodological and practical components that support the use of new technologies, from their social approach, together with the specific contributions of virtual platforms, for the implementation of a health communication proposal. Methods: an investigation with a qualitative approach was carried out at the Catholic University of Cuenca, Medicine degree from September 2021 to March 2022. Theoretical and empirical methods were used: in-depth interviews, documentary review and focal groups. Results: lack of knowledge was evidenced by the students of the Medicine degree about communication models and their implementation with the use of new technologies related to preventive health campaigns. The theoretical-methodological and practical components that support the use of new technologies were identified, together with the specific contributions of virtual platforms for the implementation of a health communication proposal on the promotion of healthy lifestyles and disease prevention, which was valued by expert criteria. Conclusions: the designed product was adequate: it provided that teachers, medical students, future professionals and health managers get prepared to effectively communicate prevention and health care campaigns in dissimilar contexts beyond the national environment.

Tecnologías 2.0 para la innovación y el desarrollo comunicacional en salud / Technologies 2.0 for innovation and communication development in health

Fundamento: las tecnologías 2.0 y las redes sociales son herramientas de comunicación que permiten a los usuarios compartir noticias; por lo que han tomado gran importancia para las autoridades sanitarias en Ecuador en temas de salud. Objetivo: indagar sobre el plan de comunicación digital que divulgó el Ministerio de Salud Pública, a través de su cuenta en Facebook, para mantener a los ciudadanos informados sobre las medidas de bioseguridad contra la COVID-19 y su contribución a la educación en salud. Métodos: se realizó una investigación con enfoque cualitativo en la página oficial de Facebook del Ministerio de Salud Pública del Ecuador durante los meses enero-julio de 2021. Se utilizaron métodos teóricos para la fundamentación de la investigación y empíricos: la observación y la entrevista a profesionales relacionados con el rubro de la comunicación digital. Resultados: la campaña #JuntosPorLaSalud fue desarrollada bajo un estilo de tipo informativo y de tono formal para la creación de contenidos con imágenes; además como protocolo de seguridad de la información se colocó la palabra FALSO, una marca de agua para mostrar el fraude y el mal uso interpretativo de los post en tiempos de pandemia; de esta manera mantuvo un margen institucional respetable y de credibilidad frente a los usuarios. Conclusiones: el plan comunicacional digital divulgado en Facebook sirvió como un canalizador y altavoz de los mensajes emitidos por la institución; en todo momento se logró mantener a los usuarios informados sobre temas de prevención, bioseguridad y vacunas contra la COVID-19.

Background: 2.0 technologies and social networks are communication tools that allow users to share news; therefore, they have taken on great importance on health issues for the health authorities in Ecuador. Objective: to inquire about the digital communication plan published by the Ministry of Public Health, through its Facebook account, to keep citizens informed about biosecurity measures against COVID-19 and its contribution to health education. Methods: an investigation with a qualitative approach was carried out on the official Facebook page of the Ministry of Public Health of Ecuador from January to July 2021. Theoretical methods were used to support the investigation and empirical ones: observation and interview with professionals related to the field of digital communication. Results: the #JuntosPorLaSalud campaign was developed under an informative style and a formal tone for the creation of content with images; in addition, as an information security protocol, the word FALSE was placed, a watermark to show fraud and misuse of posts in times of pandemic; In this way, it maintained a respectable institutional margin and credibility with respect to users. Conclusions: the digital communication plan disclosed on Facebook served as a channel and loudspeaker for the messages issued by the institution; at all times it was possible to keep users informed on issues of prevention, biosecurity and vaccines against COVID-19.

Formação em enfermagem, mídias sociais e as competências de gestão / Educación en enfermería, medios de comunicación social y habilidades de gestión / Nursing education, social media, and management skills

Objetivo: Descrever o uso de mídias sociais como recurso para a formação em enfermagem a partir da implementação de competências gerenciais. Método: Trata-se de relato de experiência, executado a partir dos relatórios de um projeto de extensão universitária, executado entre 2020 e 2021, usando como análise, por meio da teoria de aprendizagem de Vygotsky. Resultado: O estudo mostra as atividades executadas ao gerenciamento nas redes sociais, colaborou com habilidades que corroboram para competências interligadas a autogestão, liderança, práticas colaborativas e o dimensionamento da equipe, a partir do uso da Tecnologia de Informação e Comunicação como mediador no processo de aprendizagem e formação em enfermagem. Conclusão: O desenvolvimento de competências gerenciais, ultrapassa o critério de conhecimento, mas também deve agregar as atitudes e habilidades para fortalecimento das mesmas, a partir da mediação por tecnologias para aprendizagem e formação.(AU)

Objective: To describe the use of social media as a resource for nursing education from the implementation of managerial skills. Method: This is an experience report, executed from the reports of a university extension project, executed between 2020 and 2021, using as analysis, through Vygotsky's learning theory. Result: The study shows the activities performed to management in social networks, collaborated with competencies that corroborate skills interconnected to self-management, leadership, collaborative practices and team sizing, since the use of Information and Communication Technologies as a mediator in the learning process and training in nursing. Conclusion: The development of management skills goes beyond the criterion of knowledge, but should also add the attitudes and skills to strengthen them, from the mediation by technologies for learning and training.(AU)

Objectivo: Describir el uso de los medios sociales como recurso para la formación en enfermería a partir de la implementación de competencias gerenciales. Método: Se trata de un relato de experiencia, ejecutado a partir de los relatos de un proyecto de extensión universitaria, ejecutado entre 2020 y 2021, utilizando como análisis, por medio de la teoría de aprendizaje de Vygotsky. Resultados: El estudio muestra las actividades realizadas en la gestión de las redes sociales, colaborando con habilidades que corroboran para las competencias interligadas a la autogestión, el liderazgo, las prácticas colaborativas y el dimensionamiento del equipo, a partir del uso de la Tecnología de la Información y la Comunicación como mediador en el proceso de aprendizaje y formación en enfermería. Conclusión: El desarrollo de competencias gerenciales, ultrapasa el criterio de conocimiento, pero también debe agregar las actitudes y habilidades para el fortalecimiento de las mesmas, a partir de la mediatización por tecnologías para el aprendizaje y la formación.(AU)

Percepção de motoristas de Uber sobre condições de trabalho e saúde no contexto da Covid-19 / Uber drivers perception about their work and health conditions in the context of Covid-19

RESUMO O trabalho mediado por plataformas como a Uber vende uma ideia ilusória de 'empreendedorismo' para descaracterizar vínculos trabalhistas, sem perder o controle sobre os motoristas. Na pandemia da Covid-19, motoristas de aplicativos arcaram com custos adicionais para adotar medidas de proteção para evitar o risco de contaminação pelo Sars-CoV-2. Estudo descritivo e comparativo conduzido a partir de uma amostra de conveniência com motoristas da plataforma Uber. O instrumento de pesquisa foi a aplicação virtual de questionário desenvolvido pelos pesquisadores com contribuições de representantes de associações e sindicato da categoria. De um grupo com cerca 500 motoristas Uber de grupos de WhatsApp, 104 motoristas participaram do estudo, dos quais 50tem jornadas de onze horas diárias ou mais e 24trabalham sete dias por semana. Na pandemia, 79referiram redução das horas trabalhadas, 96diminuição da renda e 17tiveram sintomas compatíveis com Covid-19. Condições precárias de trabalho foram agravadas durante a pandemia, que ressaltou a vulnerabilidade do modelo de trabalho mediado por aplicativos. Esses trabalhadores são expostos a um trabalho inseguro, sem garantias pela empresa que os contrata, e ainda assumem todos os custos e riscos do exercício profissional. Esta pesquisa deu voz aos motoristas de aplicativos e, assim, pode contribuir para a melhoria de suas condições de trabalho.

ABSTRACT Work mediated by platforms such as Uber sells an illusory idea of 'entrepreneurship' to mischaracterize labor relations, without losing control over drivers. In the Covid-19 pandemic, Uber drivers had to handle with additional costs to adopt protective measures in order to avoid risks of contamination by Sars-CoV-2. Quantitative cross-sectional study based on a convenience sample with Uber drivers. The research instrument was a questionnaire developed by the researchers, with contributions from representatives of associations and unions. Out of 500 Uber drives in the WhatsApp groups, 104 drivers participated in the study, 50referred working-hours equal or above 11 daily hours, and 24worked seven days a week. In the pandemic, 79reported a reduction in working hours, 96had a decreased income and 17presented symptoms compatible with Covid-19. Poor working conditions were aggravated during the pandemic that highlighted the vulnerability of the application-mediated work model. These drivers are exposed to unsafe work conditions, with no guarantees by the hiring company, and also assume all costs and risks of their professional practice. This study gave voice to these drivers and, thus, it can contribute to propose improvements of their working conditions.

Alternativa interactiva con la plataforma Moodle para la enseñanza-aprendizaje de la asignatura Pedagogía / Interactive alternative with the Moodle platform for the teaching-learning of the Pedagogy subject

RESUMEN Fundamento: el desarrollo de las Tecnologías de la Información y las Comunicaciones en la educación se convierte en una herramienta didáctica y pedagógica. Objetivo: diseñar una alternativa interactiva con el empleo de la plataforma Moodle para la enseñanza-aprendizaje de la asignatura Pedagogía de la carrera Licenciatura en Tecnología de la Salud. Métodos: se realizó un estudio de desarrollo con el empleo de una metodología cualitativa y cuantitativa en la Facultad de Ciencias Médicas de Sagua la Grande durante el curso 2018-2019. Se emplearon los métodos teóricos: analítico-sintético, inductivo-deductivo, lógico-práctico, el modelado; y empíricos: la revisión documental, entrevista, cuestionario y la observación a clase. Resultados: se diseñó la alternativa interactiva para la asignatura de Pedagogía con la aplicación de la metodología RUP (Proceso Unificado Racional) y el lenguaje UML (Lenguaje Unificado de Modelado) para el análisis, diseño, implementación y documentación de sistemas orientados a objetos y para visualizar, especificar, construir y documentar el sistema. Se montó en la plataforma Moodle con la estructura didáctica del diseño, componentes y elementos de manera que el estudiante pueda ejecutar tareas para arribar al conocimiento deseado. Conclusiones: el proceso enseñanza aprendizaje de la asignatura Pedagogía ha demostrado la necesidad del uso de la plataforma interactiva al usar métodos desarrolladores en los educandos, utilizados en formas organizativas presenciales y semipresenciales, los que posibilitan su generalización en el pregrado y posgrado.

ABSTRACT Background: the development of Information and Communication Technologies in education becomes a didactic and pedagogical tool. Objective: to design an interactive alternative with the use of the Moodle platform for the teaching-learning of the Pedagogy subject of the Bachelor's degree in Health Technology. Methods: a development study was carried out using a qualitative and quantitative methodology at the Faculty of Medical Sciences of Sagua la Grande during the 2018-2019 academic year. Theoretical methods were used: analytical-synthetic, inductive-deductive, logical-practical, modeling; and empirical ones: documentary review, interview, and questionnaire and class observation. Results: the interactive alternative for the Pedagogy subject was designed with the application of the RUP (Rational Unified Process) methodology and the UML (Unified Modeling Language) language for the analysis, design, implementation and documentation of object-oriented systems and for visualize, specify, build and document the system. It was assembled on the Moodle platform with the didactic structure of the design, components and elements so that the student can carry out tasks to arrive at the desired knowledge. Conclusions: the teaching-learning process of the Pedagogy subject has shown the need to use the interactive platform by using developeing methods in students, used in face-to-face and blended organizational forms, which allow its generalization in undergraduate and postgraduate courses.

La herramienta Actividad Tarea de la plataforma Moodle aplicada a trabajos de terminación de curso / The Activity Task tool of the Moodle platform applied to course completion projects

RESUMEN Fundamento: las plataformas interactivas favorecen el proceso enseñanza aprendizaje en el modelo a distancia, semipresencial y presencial al ofrecer herramientas para el diseño y creación, mantenimiento y desarrollo de aulas virtuales. Objetivo: describir las experiencias del uso de la herramienta Actividad Tarea de la plataforma interactiva Moodle en el desarrollo del trabajo de terminación de curso por los estudiantes universitarios. Métodos: el estudio se realizó en la Facultad de Cultura Física de la Universidad Central "Marta Abreu" de Las Villas, Villa Clara, durante el curso 2021-2022. Se emplearon métodos teóricos: análisis-síntesis e inducción-deducción; y empíricos: análisis documental, análisis del contenido del trabajo de terminación de curso utilizando la Actividad Tarea de la plataforma Moodle, a partir de elementos solicitados en una guía; y la entrevista a estudiantes. Resultados: se evidenció que el uso de la herramienta Actividad Tarea facilitó la ejecución del trabajo de terminación de curso, así como su revisión por los profesores. El cumplimiento del cronograma donde se programaron los diferentes aspectos de interacción estudiante-profesor favoreció la obtención de resultados positivos en ascenso gradual hasta alcanzar evaluaciones sobresalientes; los estudiantes se sintieron motivados y emitieron criterios de satisfacción sobre la metodología empleada. Conclusiones: la aplicación de la herramienta Actividad Tarea de la plataforma interactiva Moodle en el desarrollo del trabajo de terminación de curso resultó una experiencia positiva y aplicable en los centros de educación superior, porque contribuyó a lograr un aprendizaje significativo en la ejecución de esta forma evaluativa.

ABSTRACT Background: interactive platforms favor the teaching-learning process in the distance, blended and face-to-face learning model by offering tools for the design and creation, maintenance and development of virtual classrooms. Objective: to describe the experiences of the use of the Task Activity tool of the Moodle interactive platform in the development of course completion work by university students. Methods: the study was carried out at the Faculty of Physical Culture of the "Marta Abreu" Central University of Las Villas, Villa Clara, during the 2021-2022 academic year. Theoretical methods were used: analysis-synthesis and induction-deduction; and empirical: documentary analysis, analysis of the content of the course completion work using the Task Activity of the Moodle platform, based on elements requested in a guide; and student interview. Results: it was evidenced that the use of the Task Activity tool facilitated the execution of the course completion work, as well as its review by the teachers. Compliance with the schedule where different aspects of student-teacher interaction were scheduled favored the achievement of positive results in gradual ascent until reaching outstanding evaluations; the students felt motivated and expressed satisfaction criteria about the methodology used. Conclusions: the application of the Activity Task tool of the Moodle interactive platform in the development of course completion work was a positive and applicable experience in higher education centers, because it contributed to achieving significant learning in the execution of this evaluative form.

Diseño de un software educativo para la asignatura de Rehabilitación II / Design of an educational software for the subject of Rehabilitation II

RESUMEN Introducción: según la Organización Mundial de la Salud, el software educativo ha revolucionado el modelo pedagógico tradicional hacia nuevos modelos didácticos, donde el espacio, el tiempo y los recursos para el aprendizaje no están limitados. Objetivo: diseñar un software educativo como soporte bibliográfico para la asignatura Rehabilitación II, de la carrera Estomatología. Métodos: se realizó una investigación de innovación tecnológica en la Facultad de Estomatología de la Universidad de Ciencias Médicas de Villa Clara, durante el curso 2018-2019. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético, e inductivo-deductivo; empíricos: revisión de documentos, entrevista no estructurada a estudiantes de otros años superiores y a directivos y otros docentes de la facultad, y cuestionario a estudiantes. Para la confección de la software educativo se utilizaron los programas: Notepad++, Paint, Photoshow, Microsoft Office Power Point y Wondershare Photo Story Platinum. Resultados: el análisis documental confirmó carencias de bibliografías y medios de enseñanza para el estudio e impartición de los contenidos de la asignatura, lo cual fue confirmado por los informantes clave. La mayoría de los estudiantes prefirieron como medio de obtención de la información un software educativo, el cual fue diseñado y valorado por criterios de especialistas. Conclusiones: por su información el software educativo es un recurso capaz de ser utilizado como medio de enseñanza en la impartición y estudio de la asignatura. Fue valorado por especialistas como un material funcional, de aplicabilidad, atractivo, factible y original.

ABSTRACT Background: according to the World Health Organization, educational software has revolutionized the traditional pedagogical model towards new didactic models, where space, time and resources for learning are not limited. Objective: to design an educational software as a bibliographic support for the Rehabilitation II subject, of the Dentistry degree. Methods: a technological innovation research was carried out at the Faculty of Dentistry of the Villa Clara University of Medical Sciences, during the 2018-2019 academic year. Theoretical methods were used: historical-logical, analytical-synthetic, and inductive-deductive; Empirical ones: review of documents, unstructured interview with students from other higher years and with directors and other teachers of the faculty, and questionnaire to students. For the preparation of the educational software, the following programs were used: Notepad++, Paint, Photoshop, Microsoft Office Power Point and Wondershare Photo Story Platinum. Results: the documentary analysis confirmed the lack of bibliographies and teaching aids for the study and teaching of the contents of the subject, which was confirmed by the key informants. Most of the students preferred an educational software as a means of obtaining information, which was designed and valued by specialist criteria. Conclusions: due to its information, educational software is a resource capable of being used as a teaching aid in the teaching and study of the subject. It was valued by specialists as a functional, applicable, attractive, feasible and original material.

Competencias informacionales en los profesionales del Hospital Ginecobstétrico Docente en Palma Soriano, Cuba / Informational competences in the professionals of the Teaching Gynecological-Obstetric Hospital in Palma Soriano, Cuba

RESUMEN Fundamento: la inserción de las competencias informacionales en la labor del profesional de ciencias médicas supone la gestión de nuevos roles que integren el consumo de información digital, la generación de nuevos conocimientos y su socialización. Objetivo: caracterizar el desarrollo de competencias informacionales en los profesionales de salud pertenecientes al Hospital Ginecobstétrico Docente del municipio Palma Soriano en la provincia Santiago de Cuba. Métodos: se realizó un estudio descriptivo en el Hospital Ginecobstétrico Docente "Nelia Irma Delfín Ripoll", durante el año 2020, en Palma Soriano. Se emplearon métodos teóricos: análisis-síntesis e inductivo-deductivo y enfoque sistémico; empíricos: análisis documental, el cuestionario y la observación. Resultados: se constató un predomino de la escolaridad universitaria, necesidad de información como algo objetivo, inadecuada utilización de estrategias de búsqueda, tipo de fuentes informativas utilizadas digitales para el autoestudio, inadecuado trabajo colaborativo y de grupos de discusión para la investigación. Conclusiones: se caracterizó el desarrollo de competencias informacionales en los profesionales de salud pertenecientes al Hospital Ginecobstétrico Docente en Palma Soriano, con vistas a lograr una amplia cobertura temática y calidad de los contenidos de la organización en los sistemas de gestión y el desarrollo de competencias informacionales que propicien la retroactividad en el enfrentamiento de los problemas de salud.

ABSTRACT Background: the insertion of informational competences in the work of the medical science professional implies the management of new roles that integrate the consumption of electronic information, the generation of new knowledge and its socialization. Objective: to characterize the development of informational competences in health professionals belonging to the Teaching Gynecological-obstetric Hospital of Palma Soriano municipality in Santiago de Cuba province. Methods: a descriptive study was carried out at "Nelia Irma Delfín Ripoll" Gynecological-obstetric Teaching Hospital, in Palma Soriano during 2020, Theoretical methods were used: analysis-synthesis and inductive-deductive and the systemic approach; empirical ones: documentary analysis, questionnaire and observation. Results: there was a predominance of university education, the need for information as something objective, inadequate use of search strategies, type of information sources used electronically for self-study, inadequate collaborative work and discussion groups for research. Conclusions: the development of informational competences in health professionals belonging to the Teaching Gynecological-Obstetric Hospital in Palma Soriano was characterized, with a view to achieving a wide thematic coverage and quality of the contents of the organization in the management systems and the development of informational competencies that promote retroactivity in the confrontation of health problems.

A Socio-technical Approach to Evaluating an Electronic Medical Record System implemented in the Public Health Services of Aguascalientes / Una Aproximación Socio-técnica a la Evaluación de un Expediente Médico Electrónico implementado en Servicios de Salud Públicos de Aguascalientes

Abstract The objective of this study was to explore a strategy for evaluating an Electronic Medical Record (EMR) system implemented in the public health services of Aguascalientes, Mexico. A questionnaire based on DeLone and McLean's Model of Information Systems Success (MISS) was adapted to Spanish and applied with 62 primary care physicians working in health centers of the Instituto de Servicios de Salud del Estado de Aguascalientes (ISSEA or the State of Aguascalientes Institute for Health Services). Opportunities for improving EMR systems were also explored from the informants' perspectives. Additionally, the relationships between MISS components were analyzed using Structural Equations Modeling (SEM). Some MISS components and particular items (service quality and overall satisfaction) presented low averages, reflecting opportunities for improving the development and implementation of EMR, such as the need to continuously update information pertaining to diagnostic and medicine catalogs and develop systems that are interoperable between the second and third levels of care. In conclusion, the present study contributes generating evidence on the use of the MISS to evaluating EMR systems in public health services of Mexico. More evidence should be generated in this field in order to promote the continuous improvement of these information systems.

Resumen El objetivo de este estudio fue explorar una estrategia para la evaluación de un Expediente Clínico Electrónico (ECE) implementado en servicios de salud públicos de Aguascalientes, México. Se adaptó al español un cuestionario basado en el Modelo de Éxito de Sistemas de Información (MISS) de DeLone y McLean y se aplicó a 62 médicos de atención primaria que trabajan en centros de salud del Instituto de Servicios de Salud del Estado de Aguascalientes (ISSEA). Se exploraron también las oportunidades de mejora del ECE desde la perspectiva de los informantes. Además, se analizaron las relaciones entre los componentes del MISS mediante el modelado de ecuaciones estructurales (SEM). Algunos componentes del MISS e items particulares mostraron promedios bajos (p.ej., calidad del servicio y satisfacción) que reflejan algunas oportunidades de mejora en el desarrollo e implementación del ECE, como la necesidad de una actualización continua de la información sobre diagnósticos y catálogos de medicamentos; y el desarrollo de sistemas de interoperabilidad con el segundo y tercer nivel de atención. En conclusión, el presente estudio contribuye en la generación de evidencia sobre el uso del MISS para evaluar los sistemas de EMR en servicios de salud públicos de México. Se debe generar más evidencia en este campo para promover la mejora continua de estos sistemas de información.

Pantallas, niños y confinamiento en pandemia: ¿debemos limitar su exposición? / Screens, children and lockdown in pandemics: should we limit their exposition?

Desde la aparición del cine, hace más de un siglo, hasta la actual invasión de dispositivos móviles, la velocidad en la evo-lución de las pantallas ha sido exponencial, y se ha acompañado de nuevas formas de consumir medios audiovisuales, de comunicarnos y de administrar nuestro tiempo de ocio. Las aplicaciones han dado un salto desde la computadora de escritorio a los smartphones, lo que facilitó su acceso en cualquier lugar y momento, haciendo que los niños y adolescentes de hoy (generación Z, nativos digitales y neodigitales) tengan más acceso a medios electrónicos que cualquier otra generación previa. En paralelo, ha crecido la preocupación por el efecto que estas pantallas podrían tener sobre el desarrollo infantil. A partir de los resultados de varias investigaciones, diferentes entidades desarrollaron recomendaciones sobre el uso de pantallas en niños, fijando la mayoría de ellas un límite "seguro" de consumo de dos horas al día. Sin embargo, la evidencia que las respalda es muy débil. Dada la actual situación de pandemia, que obliga a confinarnos en nuestros hogares, alejados físicamente de otras personas y sin acceso a actividades recreativas en el exterior, la mayoría de estas recomendaciones suenan bastante limitantes y difíciles de cumplir. Este artículo propone: 1) repasar la información disponible sobre el consumo de pantallas en niños, 2) exponer la evidencia que respalda las actuales recomendaciones de diferentes instituciones respecto de su uso, 3) evaluarla críticamente, visibilizando los vacíos de conocimiento, para jerarquizarlos a la hora de aconsejar sobre crianza a las familias que atendemos. (AU)

Since the creation of cinema more than a century ago, and until the current invasion of mobile devices, the speed in the evolution of the screens has been exponential, which comes with new ways of consuming multimedia, communicating and managing our leisure time. Applications have made a leap from desktop computers to smartphones, facilitating their access anywhere and anytime, allowing children and teenagers today (Generation Z, digital and neo-digital natives) to have moreaccess to electronic media than any other previous generation. At the same time, concern has grown about the effect these screens could have on child development. Based on the results of several investigations, different entities developed recommendations on the use of screens in children, setting most ofthem a "safe" limit of consumption of two hours a day. However, the supporting evidence is very weak.In the context of the current pandemic, which forces us to confine our selves to our homes, physically away from other people and without access to recreational outdoor activities, most of these recommendations sound quite limiting and difficult to accomplish. This article proposes: 1) to review the information available on-screen consumption in children, 2) to expose the evidence that supports current recommendations of different institutions regarding its use, 3) to critically evaluate it, making the gapsin knowledge visible, in order to prioritize them when giving the families we care for advice on parenting. (AU)

Application of ISO9000 quality management systems in science &technology management in college / 中华医学科研管理杂志

Objective To establish a set of sound and scientific managing procedures and systems that conforms with the current needs and reform of the scientific research management methods .Methods Based on the current operation status of the scientific research management system in colleges of domestic universities ,this paper expounds and analyzes the theory and method of holistic quality management from the perspective of ISO9000 quality management system .Results Bring in the ho-listic quality management idea into the fields of college management ,especially cater to the science and technology management in college .Conclusions Provided a reference for bring in and comprehensive construction of ISO 9000 quality management sys-tem in scientific research management in colleges at universities .

Practice of improving the efficiency of scientific and technological innovation in hospital from the perspective of modern hospital management / 中华医学科研管理杂志

Objective To explore the importance of establishing and improving modern hospital science and technology management system in public hospitals,as well as the ways of establishing such system,analyze the key points that need consideration in order to provide reference for establishing modern hospital science and technology management system in public hospitals.Methods Starting from the reform requirements and perspectives of the construction of modern hospital management system,and based on the theory of innovative governance,this paper probes into the innovative practice and achievements of our hospital in implementing the internal scientific and technological management system of modern hospitals from three aspects:the incentive mechanism,the restraint mechanism and the coordination mechanism of innovative governance of scientific and technological management system.Results Through the establishment and improvement of internal scientific and technological management system,such as reward policies for scientific research work,reward and punishment for papers,layout fee management guidelines,management methods for scientific research funds,project evaluation policies,selection and training of subject leaders,temporary management methods for medical research institutes,and implementation methods for scientific research integrity construction,the effect of talent aggregation is gradually presented,and the discipline,team and technology are stable.Step by step development;innovative achievements are increasingly fruitful,and the quality of connotation is constantly improving.Conclusions The key to the establishment of modern hospital science and technology management system is to continuing innovative exploration of the system of science and technology management and to build a good operation mechanism of science and technology innovation.

Gestión de equipos médicos: implementación y validación de una herramienta de auditoría / Health technology management: implementation and validation of an audit tool

Resumen: La auditoría en salud es un proceso dinámico y en continuo avance que permite evaluar y controlar estándares de calidad en las instituciones de salud, sin embargo, la falta de estandarización y confiabilidad de resultados sigue siendo un reto por superar. Este trabajo presenta la validación de un prototipo de herramienta de auditoría para la gestión de equipos médicos la cual se realizó en dos fases: primero durante la implementación en tres hospitales del Área Metropolitana del Valle de Aburra, en Antioquia, Colombia, y posteriormente a través del análisis estadístico del juicio de expertos. Los hallazgos permitieron generar acciones de mejora con base en los informes de fortalezas y debilidades puntuales. Por su parte las mediciones de coeficientes de confiabilidad (Cronbach α= 0.90) y correlación de expertos (Spearman =0.88) indicaron resultados favorables para la herramienta. Además, la medición de promedios, desviaciones estándar y coeficientes de variación para cada ítem de la validación, expuso las mejoras que requiere la herramienta para una versión futura. La propuesta de la herramienta se limita a la regulación en salud Colombiana sin embargo no se aleja del marco normativo internacional, por lo que se considera es un paso relevante importante para convertir las auditorias en salud en procesos estandarizados. Puede concluirse que integrar al ingeniero biomédico en actividades de auditoría de calidad en salud con herramientas confiables ofrece un beneficio importante para la toma de decisiones oportuna en la gestión de los equipos médicos.

Abstract: Audit in health is a dynamic process and continuous advancement that permits to asses monitor and improve quality standards in healthcare institutions; however, the lack of standardization and reliability of results remains a challenge to be overcome. This study presents the validation of a prototype of an audit tool to the management of medical equipment which took place in two phases: first during the implementation in three hospitals in the metropolitan area of Antioquia, Colombia, and subsequently through the statistical analysis of the trial of twelve selected experts. As results audit reports were generated with strengths and weaknesses points, which enabled us to build improvement measures suitable for hospitals. Measurements of coefficients of reliability (Cronbach α= 0.90) and correlation of experts (Spearman =0.88) indicated favorable results for the tool. In addition, the measurement of mean, standard deviations and coefficients of variation for each item of the validation set out the improvements required by the tool for a future version. This tool is limited to the health regulation in Colombia; nevertheless, the tool is an important step to find and transform the health audits in standardized process that can have an objective assessment. To can be concluded to integrate the biomedical engineer in the activities of audit quality on health with reliable tools offers an important benefit for accurate decision making and timely management of the medical equipment.

Survey and analysis on clinical engineering departments in Guangdong under new regulations / 医疗卫生装备

Objective To investigate the status quo of clinical engineering departments (CED) in Guangdong province, to find out the main problems and challenges, and to give some suggestions on promoting the development of clinical engineering. Methods Questionnaires were issued to directors or engineers in hospitals on department missions, staff composition, quality control and obstructive factors for discipline development. Statistical analysis was executed for the questionnaires. Results Only 53.19% of the CED operated independently. The daily CE practice in Guangdong hospitals included carrying out procurement, installation, maintenance and archiving. Only 28.0%of the hospitals had QC instruments. The education backgrounds were mainly restrained in undergraduate degree and junior college degree, accounting for 80.0%. Totally 39.0% of the clinical engineers majored in biomedical engineering. The personnel with primary or intermediate professional titles accounted for 61.96%. There was 0.68 engineer per 100 beds or 0.23 engineer per ten million Yuan medical equipment. The top 3 factors that hindered the development of CE were inadequacy of professional staff, low education level and absence of laws and regulations. Conclusion CED in Guangdong province drops behind the outstanding institutions in China, and has to be promoted with the efforts of supervision facilities and etc.

Diseño de modelo de capacitación en procesos asistenciales relacionados con dispositivos médicos / Training model design in healthcare services involving medical devices / Desenho de modelo de capacitação em processos assistenciais relacionados com dispositivos médicos

El continuo mejoramiento de la calidad en la atención en salud evidencia la necesidad de ejecutar planes constantes de capacitación al personal asistencial, tanto en procesos institucionales como en uso seguro de tecnologías biomédicas. Para ello se requiere definir el personal que garantice la implementación de las capacitaciones sin afectar la prestación de servicios de salud de la institución, considerando el número de personas a capacitar y los servicios a los cuales pertenecen, el tiempo necesario para capacitarlo en un tema, y el tamaño de los grupos de trabajo del personal asistencial. En este artículo se presenta un modelo de capacitaciones dirigido al personal asistencial, diseñado a partir de modelos instruccionales que favorecen la formación del conocimiento y habilidades, sustentado en el modelo pedagógico de la Universidad de Antioquia y la metodología Análisis, Diseño, Desarrollo, Implementación y Evaluación. El modelo presentado entrega los parámetros para diseñar un plan de capacitaciones que permita impactar sobre el personal asistencial, sin afectar los servicios de la institución, y que esto se refleje en la calidad de la atención en salud.

The continued improvement of quality in health care services evidences the need to implement regular training plans for nursing staff, both in institutional programs and safe use of health care technology. It is thus necessary to establish a training team to guarantee that implementation of the training does not affect the institution's provision of health care services, considering the number of people to train and the departments to which they belong, the time necessary to train the staff on a subject, and the nursing staff working group's size. This article presents a training model for nursing staff based on instructional models that encourage the construction of knowledge and skills, themselves based on the pedagogical model of the University of Antioquia and the Analysis, Design, Development, Implementation and Evaluation methodology. The model presented provides the parameters to design a training plan that impacts nursing staff without affecting the institution's services, and which is reflected in the quality of health care.

A contínua melhoria da qualidade na atenção em saúde evidência a necessidade de executar planos constantes de capacitação ao pessoal assistencial, em processos institucionais como no uso seguro de tecnologias biomédicas. Para isso, se requer definir o pessoal que garanta implementar as capacitações sem afetar a prestação de serviços de saúde da instituição, considerando o número de pessoas para capacitar e os serviços aos quais pertencem, o tempo necessário para capacitá-lo num tema, e o tamanho dos grupos de trabalho do pessoal assistencial. Neste artigo apresenta-se um modelo de capacitações dirigido ao pessoal assistencial, desenhado a partir de modelos instrutivos que favorecem a formação do conhecimento e habilidades, sustentado no modelo pedagógico da Universidade de Antioquia e a metodologia Análise, Desenho, Desenvolvimento, Implementação e Avaliação. O modelo apresentado entrega os parâmetros para desenhar um plano de capacitações que permita impactar sobre o pessoal assistencial, sem afetar os serviços da instituição, e que isto se reflita na qualidade da atenção em saúde.