Research status of organizational structure and service process of enhanced recovery after surgery / 中华医院管理杂志

Enhanced recovery after surgery(ERAS)is not only an evidence-based set of perioperative interventions, but also a highly innovative multidisciplinary collaboration model and organizational system. The authors reviewed the research status of the organizational structure and service process of ERAS at home and abroad, elaborated the establishment mode and management operation system of ERAS-multidisciplinary team(ERAS-MDT), discussed the communication mechanism between the teams to strengthen the communication and cooperation of ERAS-MDT, and emphasized the reasonable allocation of human resources of ERAS-MDT to reduce the workload of members. At the same time, the authors reviewed the standardized clinical pathway to facilitate the connection of all aspects during the perioperative period, and through the quality control and quality improvement measures of ERAS mode, the authors hope to further standardize the ERAS service process and escort the efficient operation of ERAS.

Relationship between acupuncture sensations of and different organizational structures of acupoint area / 中国针灸

Acupuncture sensation, as one of the essential signs of (arrival of ), is closely associated with curative effect. With systematically reviewing the literature regarding relationship between acupuncture sensations of and different organizational structures of acupoint area (skin, connective tissue, muscles, nerves and blood vessels), it is believed that acupuncture sensation of is the product of various organizational structures in acupoint area, which is closely related to the nervous system. The sensations sensed by the hands of acupuncturists, which is called sense of needle stagnation, maybe caused by the contraction of muscles in the acupoint area during the process of needle manipulation. By system review, this paper puts forward a new research idea to explore the role of different manipulations of needling in generating the sense of -generating needle based on different acupoint structure and brain function response system, which could provide some reference for clarifying the scientific mechanism and clinical application of acupuncture sensations of .

El diseño curricular de cursos en Educación Médica / Curriculum design in medical education courses

Se presenta un trabajo que aborda la superación profesional en la Educación Superior en la forma organizativa de "Curso", de acuerdo a lo establecido en el Reglamento de la Educación de Posgrado del Ministerio de Educación Superior, (Res 132/2004), con aplicación específica a la Educación Médica. Se profundiza en los componentes didácticos y metodológicos para el diseño de los cursos, partiéndose de forma necesaria de la identificación de necesidades aprendizaje de los profesionales de la salud sobre determinados problemas de salud y/o docentes que demandan solución en una institución de salud o a cualquier otro nivel del Sistema Nacional de Salud. Se detallan los componentes de la estructura curricular, con énfasis en la redacción de los objetivos, -el general del curso y los temáticos- con un enfoque constructivista, las tareas docentes incluidas dentro del propio diseño, la utilización de métodos problémicos y de discusiones grupales que propicien la autopreparación, y el intercambio entre los profesionales, la evaluación del aprendizaje y la evaluación del curso(AU)

We present a paper that addresses the professional improvement in higher education in the course as an organizational form, according to the Regulations of Postgraduate Education of the Ministry of Higher Education (Regulation 132/2004), with specific application to medical education. The teaching and methodological components for the design of the courses are deepened, starting from a necessary way of identifying the learning needs of the health professionals on certain health problems, and/or teachers who demand a solution in a health institution or at any other level of the National Health System. It details the components of the curricular structure, with emphasis on the writing of the objectives --the general of the course and the subjects--, with a constructivist approach, the teaching tasks included within the own design, the use of problematic methods and group discussions for self-training, and the exchange among professionals, assessment of learning, and evaluation of the course(AU)

Effects of coal-burning type of fluorosis on hypothalamic-pituitary-ovary axis function in female rats / 中华地方病学杂志

Objective To observe the influence of coal-burning type of fluorosis on hypothalamic-pituitaryovary axis function and to explore possible mechanism in female rats.Methods Sixty SD rats were divided into two groups according to body weight with the method of random number table:control group and fluorosis group,30 rats in each group.Fluorosis group was feed with corn powder baked by high fluorine coal from Zhijin area.Changes of female rats' teeth during fluorine exposure were observed.After feeding for 180 days,24 h urine was collected in estrus and fluorine level was tested using fluoride ion-selective electrode; rats were executed and bone fluorine level was tested with high-temperature ashing-fluorine ion-selective electrode.Femoral artery blood was collected and serum was separated to test the contents of follicle stimulating hormone (FSH),luteinizing hormone (LH),testosterone (T),estradiol (E2) and progesterone (P) with electrochemiluminescence radioimmunoassay and gonadotropin-releasing hormone (GnRH),inhibin (INH) with enzyme-linked immunosorbent assay (ELISA),respectively.Organs,including hypothalamus,pituitary gland and ovary were weighted,and organ coefficients were calculated.Pathological morphology of hypothalamus,pituitary gland and ovary was observed after staining and ultrastructure of ovary was examined by electron microscopy.Results Coal-burning induced fluorine poisoning rat model was established successfully.There were no significant differences statistically in organ coefficients between fluorosis groups (0.032 ± 0.004,0.014 ± 0.008,0.037 ± 0.009) and controls (0.035 ± 0.005,0.012 ± 0.006,0.035 ± 0.004,t =0.46,0.87,0.64,all P ＞ 0.05).Rats serum GnRH,FSH,LH and T levels [(21.654 ± 4.765),(29.580 ± 5.221),(53.988 ± 6.506),(23.962 ± 2.255)μg/L] of fluorosis groups were all higher than those of controls [(10.384 ±2.250),(19.217 ± 4.743),(30.314 ± 4.443),(7.883 ± 1.973)μg/L,t =6.762,4.646,9.503,16.971,all P ＜ 0.05].But the level of P,INH [(12.635 ± 3.841),(18.926 ± 3.465)μg/L] were all lower than those of controls [(21.045 ±4.768),(48.076 ± 3.525)μg/L,t =4.344,18.649,all P ＜ 0.05].Serum E2 levels of control group and fluorosis group were (35.375 ± 10.662) and (27.500 ± 12.783)μg/L,respectively.The difference between groups was not statistically significant (t =1.821,P ＞ 0.05).No pathological changes were observed in the two groups of female hypothalamus,pituitary tissue by light microscopy and electron microscopy.Under light microscope,in the control group of normal ovarian tissue,more corpus luteum and different developmental stages of follicles were seen,granulosa cells were neatly arranged in a monolayer or multilayer.In fluorosis group,severe edema of ovarian interstitial cells and follicle degeneration increased.Cell structure and cell contours were blurred and unclear with occasional mature follicles.Under transmission electron microscope,in control group,normal ovarian granulosa cell ultrastructure was observed,nuclei were round,nuclear chromatin was uniform distributed,cytoplasm was rich in mitochondria and endoplasmic reticulum,and normal morphology.In fluorosis group,granulosa cells and interstitial cells showed apoptotic characters,such as nucleoli disappearing,mitochondrial swelling and chromatin aggregating at the nuclear membrane.Conclusions Fluorosis can induce ovarian tissue apoptosis,severely damage the micro environment.Reduction of P and INH affects ovarian,maturation and ovulation and leads to secretion of GnRH,FSH and LH.Fluorosis caused by coal-burning may induce the injury of ovary and cause abnormal secretion of hypothalamic-pituitary-ovary axis.Fluorosis has affected parts of female axis which may not be in the hypothalamus,pituitary,but causes ovarian tissue damage.

Insight on public hospital organizational structure for hospital groups / 中华医院管理杂志

The authors described the hospital group reform made by Jiangsu Kangfu Medical Group,and its main actions taken and initial success in public hospital organizational structure.Based on such studies, they recommend further clarification of the rights and responsibilities, for sectional integration;appropriate adjustment to update the supervision mechanism;building of the appointment system to speed up personnel system reform.

La psiquiatría comunitaria en Cuba / Community psychiatry in Cuba

Se presenta el desarrollo de la psiquiatría comunitaria en Cuba, los factores que han contribuido a ello, y se propone cómo articular un nuevo paradigma basado en el modelo de atención comunitaria de salud mental, un modelo de organización de los servicios de salud mental más avanzado. Dicho modelo se materializa en los centros comunitarios de salud mental, con una base teórico y práctica que integra todos los aspectos que debe contemplar la atención integral al proceso salud-enfermedad, como forma de abordar este complejo sistema.

An overview is presented of the development of community psychiatry in Cuba and its contributing factors. A proposal is made about how to build a new paradigm based on the community primary health care model, a more advanced organization model for mental health services that takes shape in mental health community centers, based on a theoretical and practical foundation that integrates all the aspects of a comprehensive approach to the health-disease process as a way to deal with such a complex system.

Comparison of Hospital Nurses' Recognition of the Team System and Effects on the Nursing Organizational Team System / 간호행정학회지

PURPOSE: The purpose of this study was to identify hospital nurses' recognition of the team system and the effectiveness of the team system as an organizational structure. METHODS: A self-report questionnaire was used to collect data from 247 general hospital nurses during 4 months in 2013. Analysis was done using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and factor analysis with SPSS 18.0. program. RESULTS: There was no significant difference in nurses' recognition of team structure (t=2.06, p=.153) or effect of team structure (t=0.36, p=.549) according to use of team system. In hospitals with a team system, there were positive correlations between recognition of the effect of the team system and age (r=.25, p=.033), and total clinical career (r=.26, p=.012). In hospitals not using a team system, nurses' recognition of team structure as an organizational system (r=.31, p<.001), nurses' recognition of team structure, total (r=.30 p<.001) correlated significantly with the effects of team system. CONCLUSION: Results of this study provide a retrospection view of the team system in nursing organizational systems. The nursing team system's ultimate goal needs to be confirmed for complementary nursing care. Also, more studies on nurses' perceptions of, and effectiveness of the team system are necessary.

Estructura organizacional y su relación con la efectividad de los servicios universitarios de atención psicológica / Structure organizational and its relationship with the effectiveness of the university services of psychological attention

En este artículo se presenta un análisis acerca de la forma como se configuran los Servicios Universitarios de Atención Psicológica (SUAP), para la formación académica y profesional de los psicólogos y para la atención psicológica de los consultantes. El estudio, fundamentado en la teoría orgánica contingente, se realizó aplicando un análisis factorial exploratorio por componentes principales y un análisis factorial confirmatorio mediante un modelo de ecuaciones estructurales. Los resultados muestran que los SUAP se caracterizan por tener una estructura organizacional de tipo mecanicista, fundamentada en las variables de formalización, centralización y complejidad, las cuales tienen una relación directa con su efectividad.

This article presents an analysis about how it is configured University Services of Psychological Attention (USPA), for academic and professional formation of psychologists and for the psychological attention of users. The study based on the organic contingent theory was carried out using an exploratory factor analysis by principal components and a confirmatory factor analysis through structural equation modeling. The results show that USPA are characterized by an organizational structure of type mechanistic, based on the variables of formalization, centralization and complexity which have a direct bearing over its effectiveness.

Direção ou coordenação? Repensando a representatividade institucional da enfermagem / Direction or coordination? Rethinking the institutional representativeness of nursing / ¿Dirección o coordinación? Repensando la representatividad institucional de la enfermería

Trata-se de pesquisa descritiva, de abordagem qualitativa, do tipo documental, que teve como local o Hospital das Clínicas da Universidade Federal do Paraná (HC-UFPR), na cidade de Curitiba-PR. O objetivo foi analisar comparativamente a descrição de dois cargos que representam o Serviço de Enfermagem, adotados em modelos gerenciais distintos. A análise de conteúdo dos documentos referentes aos cargos nos respectivos modelos de gerência evidenciou diferenças significativas. Os resultados apontaram várias alterações na descrição dos cargos e, dentre elas, do termo Direção de Enfermagem para Coordenação de Enfermagem, com a supressão da autonomia e poder de decisão sobre assuntos inerentes à profissão. Conhecimento e competência no exercício profissional são condições para que o enfermeiro mantenha sua autonomia e representatividade na estrutura organizacional.

This is a documentary-type descriptive research, using a qualitative approach and, which was carried out at the Hospital of the Federal University of Paraná (HC-UFPR), in the city of Curitiba-PR. It aimed to comparatively analyze the description of two job positions that represent the nursing service, which were adopted in different managerial models. The content analysis of the documents related to the job positions in the respective management models showed significant differences. The results pointed out several changes in the description of the job positions, i.e. the term Nursing Direction was changed into Nursing Coordination, involving the suppression of autonomy and decision-making power over matters intrinsic to this profession. Knowledge and competence in the professional practice are required by the nurse practitioners in order to keep their representativeness in the organizational structure.

Se trata de una investigación descriptiva, de abordaje cualitativa, de tipo documental, que tuvo como local el Hospital de Clínicas de la Universidad Federal de Paraná (HC-UFPR), en la ciudad de Curitiba-PR. El objetivo fue analizar comparativamente la descripción de dos cargos que representan al servicio de Enfermería, adoptados en modelos gerenciales diferentes. El análisis del contenido de los documentos referentes a los cargos en los respectivos modelos de gerencia puso en evidencia diferencias significativas. Los resultados apuntaron varias alteraciones en la descripción de los cargos, entre ellas el término Dirección de Enfermería por Coordinación de Enfermería, con la supresión de la autonomía y poder de decisión sobre asuntos inherentes a la profesión. Conocimiento y competencia en el ejercicio profesional son condiciones para que el enfermero mantenga su autonomía y representatividad en la estructura organizacional.

A influência da estrutura organizacional nos controles internos de uma fundação para pesquisa, prevenção e assistência do câncer do interior paulista / The influence of the organizational structure on the internal controls of a foundation for cancer research, prevention and care in the interior of the state of São Paulo, Brazil

O estudo centra-se na discussão de que o nível da estrutura organizacional interfere nas práticas de controle interno das organizações não governamentais (ONGs), sobretudo ligadas à saúde. O objetivo deste trabalho foi o de observar a eficiência dos testes de controle interno aplicados dentro de uma estrutura organizacional da Fundação para Pesquisa, Prevenção e Assistência do Câncer, verificando a confiabilidade nos relatórios contábeis e controles operacionais. Como metodologia, realizou-se um estudo de caso em uma organização de saúde do terceiro setor. O estudo de caso ocorreu por meio de entrevistas e análises de relatórios confidenciais. Diante de uma avaliação da estrutura organizacional (das relações entre funcionários e voluntários) e da aplicação de procedimentos de avaliação da qualidade dos controles internos, avaliou-se o quanto o nível da estrutura organizacional interfere nas práticas de controle interno do hospital. Observou-se que existem mecanismos de controle estruturados na instituição, porém a execução desses controles deixa a desejar. Pode-se constatar também que o nível da estrutura organizacional interfere, sim, nas práticas de controle interno da entidade.

This work focuses on a discussion about the extent to which the level of organizational structure interferes in the internal control practices of non-governmental organizations (NGOs), especially those related to health. The objective of this work was to observe the efficiency of the internal control tests applied within the organizational structure of the Foundation for Cancer Research, Prevention and Care, checking the reliability of the accounting records and operational controls. A case study in a third sector health organization was the chosen methodology. The case study involved company interviews and the analysis of confidential reports. After an evaluation of the organizational structure (of the relations between officials and volunteers) and the application of evaluation proceedings on the quality of the internal controls, the extent to which the organizational structure interferes with the internal control practices of the hospital was assessed. It was revealed that there are structured mechanisms of control in the institution, however the implementation of these controls is inadequately performed. It was further detected that the level of the organizational structure does indeed interfere in internal control practices at the entity.

A Comparative Study on Nurses' Organizational Culture and Job Satisfaction according to the Hospital Size Differences / 산업간호학회지

PURPOSE: This study was conducted to compare the characteristics of organizational structure and occupational satisfaction among nurses in general hospital and small to medium-sized hospital and to investigate the affecting factors on their occupational satisfaction. METHODS: The study was based on the cross-sectional descriptive survey. A self-report questionnaire was used to collect data from 343 nurses between June and July, 2010. Data were analyzed by chi2-test, t-test, ANOVA, Scheffe's test, Pearson's correlation coefficient, and multiple regression using the SPSS/WIN 14.0 program. RESULTS: Hierarchical structure was dominant in general hospital whereas relationship was highly valued in small to medium-sized hospital. Occupational satisfaction was positively correlated with work environment built on relationship, innovation and tasks. Factors significantly influencing on occupational satisfaction in general hospital included innovative work environment, nurses' income and their health status (R2=40.3%). For the small to medium-sized hospital, they included innovative work environment, satisfaction in life, tasks and professionalism (R2=40.4%). CONCLUSION: Organizational structure, especially innovative work environment and relationship-oriented attitude had a significant influence on nurses' occupational satisfaction. Therefore, nursing administrators have to develop and consider organizational structure to improve occupational satisfaction.

Hitos y transformaciones en el área de Higiene y Epidemiología / Landmarks and changes in the sphere of Hygiene and Epidemiology

Desde las primeras etapas en la formación del sistema revolucionario de salud en Cuba, se ha asistido a un proceso continuo de perfeccionamiento en el que las transformaciones acontecidas, particularmente en políticas y estrategias, responden a las demandas del contexto en cada momento histórico. La importancia conferida a la prevención y control de enfermedades y daños a la salud ha hecho de los servicios higiénico-epidemiológicos una prioridad. Resultado de la revisión bibliográfica y la experiencia de la autora, el presente trabajo muestra una breve reseña de la conformación del área de Higiene y Epidemiología, en especial de los centros y unidades que la representan a nivel provincial y municipal; conjuntamente con algunas consideraciones sobre hechos y momentos que han tenido significación en los cambios acontecidos en su configuración organizativa.

Since the first stages of inception of the revolutionary health system in Cuba, there has been a continuous process of improvement in which changes, particularly in policies and strategies, responded to the demands of each specific historical period. The importance attached to prevention and control of diseases and health deterioration has turned the hygienic-epidemiological services into a priority. As a result of the literature review made by and the own experience of the author, the present paper showed a brief account of the conformation of the Hygiene and Epidemiology field, specially the centers and units representing this sector at municipal and provincial levels, together with some considerations on events and periods that have been significant for the changes made in the organization of this branch.