Como moldar o modelo de ensino no contexto da administração hospitalar após a implantação do Sistema Único de Saúde? / How to shape the teaching model in the context of hospital administration after the implementation of the Unified Health System?

O ensino médico e os programas de residência médica no Brasil sofreram grandes mudanças após a implantação do Sistema Único de Saúde (SUS). Historicamente, eles eram programados para serem desenvolvidos quase que exclusivamente dentro de um hospital-escola ligado à sua universidade de origem. Os hospitais universitários (HUs) até então eram completamente desvinculados do sistema público de saúde e cada um estabelecia as suas regras de funcionamento. Seus pacientes mesclavam-se entre os de alta, média e baixa complexidade, de acordo com uma agenda regulada pelos departamentos clínicos e a administração do hospital. O SUS deu lugar a uma descentralização da assistência, com regulação hierarquizada do fluxo de pacientes e muita ênfase na promoção da saúde, prevenção de doenças e atenção primária, com foco importante nos Programas de Saúde da Família (PSF). Por conta da hierarquização da assistência no SUS, os pacientes de menor grau de complexidade passaram a ficar "retidos" na rede assistencial de nível primário e secundário, e os HUs públicos, por força da lei, passaram a fazer parte integrante do sistema público de saúde como referência para pacientes em nível terciário de complexidade. Os gestores dos HUs viram-se diante de um dilema: como ensinar Medicina para a graduação e residência médica se os pacientes de níveis primário e secundário de complexidade passaram a não mais fazer parte da clientela desses hospitais?

Developing nursing blood borne pathogen control plan for Mansoura university hospital

Blood borne infections pose a serious threat to health and well-being of health care workers in Egypt. Hepatitis B, Hepatitis C and HIV have in common the blood borne pathway of transmission and severity of their outcome Occupational health and safety aims at prevention of such transmission at different levels eg. vaccination prevention for Hepatitis, post exposure prophylaxis and follow up after exposure. Also OSHA's final rule made it mandatory that health care facilities assumed responsibility for protection of their employees from exposure to Blood borne pathogen by eight components such as person protective equipment, universal precaution engineering control, work practice control, Hepatitis B prophylaxis training and education record keeping. The aim of this study was to design a blood borne pathogen control plan for Mansoura University hospital through assessing nurses knowledge and awareness related to Blood borne pathogen control, assessing the viability of equipment and supplies in various department in the designated hospital, designing the blood borne pathogen control plan based on the assumed data, and examining the validity of the designated plan. The study was conducted in Surgical and Obstetric units at Mansoura University hospital in ten departments. The subjects of this study were composed of two groups, namely a nursing group, and a jury group. Nursing group included 104 subjects were chosen from the above mentioned hospital departments. Jury group consisted of 50 subjects, divided into two subgroups which include 25 medical and 25 nurses Study tools included, questionnaire format aimed to assessing nurse's knowledge related to blood borne pathogen control. Checklist aimed to checking the Blood borne pathogen control plan in the studied hospital and opinionative sheet aimed to test the validity of the developing Blood borne pathogen control plan. The results revealed that nurses knowledge about the blood borne pathogen control plan was low Meanwhile, nurses knowledge was high [59 %] in relation to getting and staying vaccinated while the knowledge was low [34 %] in relation to report and get help with any needle stick accidents. Whereas nurse leaders, awareness about the Blood borne pathogen control plan was very low in addition to all the nurses leader [100.0%] were aware about the absence of training programs and an explanation of exposure control plan. All the nurses [100%] were aware about the lack of clear duties and responsibility for nursing staff in the Blood borne pathogen department. Equipments and supplies for Blood borne Pathogen control as observed in various departments were mostly observed to be available, and in a working state, and good storage. As far as the validation of the blood borne pathogen control plan presented in the study, the majority of the members of the two groups of jury agreed upon all items regarding form of the plan and upon the general evaluation items of the plan. No statistically significant differences could be detected between the two groups. It is concluded from the study that health care workers are at risk of exposure to different occupational hazards especially blood borne infection which may have a direct or cumulative deleterious effect on their health as a result of many factors such as lack of staff nurses knowledge related to blood borne pathogen prevention, lack of hospital policy and system related to blood borne prevention, lack of nurses adherence to blood borne prevention and absence of Blood borne pathogen control plan. The study recommend that report the percentage of Blood borne infection among health care working in Egypt, increase nurses' knowledge related to Blood borne infection prevention, apply control plan in different departments in different hospitals and governorate, develop policies and regulations adherent to Blood borne prevention, mandatory testing of health care workers is not justified on the basis of current scientific evidence strategies for preventing transmission of blood borne pathogens should be reviewed as new information becomes available and re-evaluated as to their effectiveness and standards for infection control practices in health care settings and mechanisms to implement and evaluate these standards should be developed

A experiência do Comitê de Bioética do Hospital São Lucas e da Faculdade de Medicina da PUCRS / The experience of the Bioethics Committee of PUCRSïs School of Medicine

O objetivo deste trabalho é relatar a experiência do Comitê de Bioética do Hospital São Lucas e da Faculdade de Medicina da PUCRS...

Da gratuidade das açöes e dos serviços de saúde / Gratuitousness of the health actions and services

Reproduz o teor de parecer emitido em 24-9-92, em torno de consulta formulada pelo Conselho Municipal de Saúde de Campinas e trata dos fundamentos constitucionais e legais da gratuidade de assistência à saúde devida ao cidadäo. Repassa a situaçäo da assistência à saúde antes e depois da Constituiçào de 1988 e da Lei Orgânica da Saúde de 1990, para concluir que a saúde hoje está enunciada como um direito público subjetivo, cuja fruiçäo independe de qualquer contribuiçäo do indivíduo. Os fundamentos jurídicos da gratuidade estäo expostos de maneira clara, sendo facilmente entendidos