Diferentes caminos para formarse y certificar como Especialista en Cirugía Plástica, Estética y Reparadora / Different paths to train and certify as a Specialist in Plastic, Aesthetic and Reconstructive Surgery

La presente publicación responde a la necesidad de encuadrar la situación actual de los profesionales de Cirugía Plástica, Estética y Reparadora. Encuadre que se presentará a partir de las diferentes instituciones y actores intervinientes y de los marcos normativos que, en la actualidad, subyacen al reconocimiento de la especialidad y de los profesionales que la ejercen.

This publication responds to the need to frame the current situation of Plastic, Aesthetic and Reconstructive Surgery professionals. This frame that will be presented from the different institutions and actors involved and the regulatory frameworks that, currently, underlie the recognition of the specialty and the professionals who practice it.

Entre protocolos e sujeitos: qualidade do cuidado hospitalar em um serviço de hematologia / Between protocols and subject: quality of hospital care in a hematology service / Entre protocolos e individuos: calidad del cuidado hospitalario en un servicio de hematología

No artigo, apresentamos parte dos resultados do estudo desenvolvido no Hospital Edgar Santos, da Universidade Federal da Bahia (HUPES), que analisou a experiência de melhoria da qualidade da assistência em um contexto de acreditação hospitalar. O artigo volta-se para o serviço de hematologia e tem seu foco na qualidade do cuidado e processos intersubjetivos. A investigação foi pautada na perspectiva qualitativa, empregando-se entrevistas e observação. Do ponto de vista teórico, os trabalhos de Campos, Cecílio e Merhy reconhecem a natureza complexa do cuidado em saúde, sua dimensão micropolítica e intersubjetiva, e a capacidade dos profissionais de produção de sentidos e de criatividade. Para compreender os processos de articulação psicossocial e de mobilização subjetiva dos profissionais empregamos conceitos da psicossociologia francesa de Enriquez e da psicodinâmica do trabalho de Dejours. A análise foi organizada em três eixos: articulação psicossocial e o imaginário de autogestão; vínculo e afeto: singularização do cuidado e clínica do sujeito; trabalho real e equipe de saúde. Destacamos como uma das principais conclusões a constituição de um imaginário de autogestão, expresso no compartilhamento de projetos, expectativas e algumas formas de interpretar e operar a realidade, que têm por base representações, afetivamente investidas, de autonomia e unidade. Ao lado de elementos técnicos, como protocolos, é realçado o julgamento profissional, próprio à dimensão intersubjetiva, permitindo a singularização do cuidado. Compreendemos que na cena assistencial o trabalho real é atravessado por ajustes que demonstram a cooperação entre os profissionais.

The article presents partial results of a study at Hospital Edgar Santos, Universidade Federal da Bahia (HUPES), Brazil, analyzing the service's experience with improvement in quality of care within a context of hospital accreditation. The article focuses on the hematology service and specifically its quality of care and intersubjective processes. The study adopted a qualitative approach, using interviews and observation. From the theoretical point of view, the work of Campos, Cecílio, and Merhy acknowledge healthcare's complex nature and micropolitical and intersubjective dimension and the capacity of health professionals to produce meanings and practice creativity. To understand the health professionals' processes of psychosocial linkage and subjective mobilization, we drew on concepts from the French school of psychosociology (Enriquez) and Dejours' psychodynamics of work. The analysis was organized along three lines: psychosocial linkage and the imaginary of self-management; bonding and affect: singularity of the subject's care and clinical case; real work and the healthcare team. One of the main conclusions is the building of a self-management imaginary, expressed in shared projects, expectations, and some forms of interpreting and operating reality, based on affectively invested representations of autonomy and unity. Alongside technical elements such as protocols, the article highlights professional judgment, proper to the intersubjective dimension, fostering the singularity of care. In our view, the real work in the patient care scene is traversed by adjustments that demonstrate team cooperation.

En este artículo presentamos parte de los resultados del estudio desarrollado en el Hospital Edgar Santos, de la Universidad Federal de Bahía (HUPES), que analizó la experiencia de mejora de la calidad de la asistencia en un contexto de acreditación hospitalaria. El artículo se dirige al servicio de hematología y centra su atención en la calidad del cuidado y procesos intersubjetivos. La investigación fue pautada desde la perspectiva cualitativa, empleando entrevistas y observación. Desde el punto de vista teórico, los trabajos de Campos, Cecílio y Merhy reconocen la naturaleza compleja del cuidado en salud, su dimensión micropolítica e intersubjetiva, y la capacidad de los profesionales para producir nuevos significados y ser creativos. Para comprender los procesos de articulación psicosocial y de movilización subjetiva de los profesionales empleamos conceptos de la psicosociología francesa de Enríquez y de la psicodinámica del trabajo de Dejours. El análisis se organizó en torno a tres ejes: articulación psicosocial e imaginario de autogestión; vínculo y afecto: singularización del cuidado y clínica del sujeto; trabajo real y equipo de salud. Destacamos como una de las principales conclusiones: la constitución de un imaginario de autogestión, traducido en compartir proyectos, expectativas y algunas formas de interpretar y manejar la realidad, que tienen como base representaciones, afectivamente invertidas, de autonomía y unidad. Junto a elementos técnicos, como los protocolos, se realza el juicio profesional, propio de la dimensión intersubjetiva, permitiendo la singularización del cuidado. Comprendemos que en la escena asistencial el trabajo real está cruzado por ajustes que demuestran la cooperación entre los profesionales.

Accreditation of public health education in India: Enhancing quality, competence and trust.

With an increase in the number of institutes offering public health education, there is a need for discussion on future directions and challenges. The World Health Report 2006 identified the need to improve the quality of public health education. There are various mechanisms and bodies that look after accreditation issues in several countries. The Council on Education for Public Health in the USA assists in the accreditation of schools of public health, as well as public health programmes. The Australian Network of Academic Public Health Institutions is actively engaged in discussions to improve the quality of its programme and institutions. In Europe, the European Agency for Accreditation in Public Health Education is responsible for accreditation. The South-East Asia Public Health Education Institutes Network facilitates accreditation of public health education in the region. In India, public health education varies across institutes. India needs an accreditation system to ensure that public health education is of the desired quality. Certain initiatives, such as conferences, consultation and the Calcutta Declaration, have been taken in the past two decades. However, the ideas mooted have yet to be translated into reality. The broad framework for accreditation may entail an institutional self-assessment against set standards, preparation of a database, cataloguing, and site visits by a peer team. There is a need for an apical body with all stakeholders participating in the process. Accreditation has specific benefits, but there are critical challenges as well. For example, the autonomy of the institutions needs to be protected, the accreditation bodies should exhibit professionalism and substantial financial resources are required. Before tackling specific criteria for accreditation, it is necessary to define a collective vision for schools of public health in India.

Influência da comunicação no processo de acreditação hospitalar / Influence of communication in the hospital accreditation process / Influencia de la comunicación en el proceso de acreditación hospitalaria

O objetivo do estudo foi analisar, na perspectiva de profissionais, as principais barreiras de comunicação vivenciadas no decorrer do processo de acreditação em um hospital privado de médio porte de Belo Horizonte. Trata-se de um estudo qualitativo, envolvendo 34 profissionais de saúde de categorias diferentes. Os resultados da pesquisa mostraram que a escassez de informação, a falta de objetividade, clareza e integridade no repasse de conhecimento favorecem a ruptura da prestação de serviços de qualidade. A comunicação organizacional é uma ferramenta eficaz para subsidiar mudanças importantes nas empresas, como o alcance da acreditação hospitalar. Articulando a mudança de forma concisa e clara no que se refere à comunicação, poderá ser alcançado perenemente o padrão de qualidade.

The research objective was to examine the perspective of professionals, the major communication barriers experienced during the Accreditation process in a medium sized private hospital in Belo Horizonte. This is a qualitative study involving 34 health professionals from different categories. The survey results showed that the shortage of information, lack of objectivity, integrity and explicitness in the transfer of knowledge favors the rupture of the provision of quality services. The organizational communication is an effective tool to support major changes in companies, as it is the scope of hospital accreditation. Articulating the change in a concise manner, with focus on the communication, can be achieved the quality standard.

El objetivo de la investigación era examinar la perspectiva de los profesionales, las barreras principales de comunicación experimentadas durante el proceso de acreditación en un hospital particular medio en Belo Horizonte. Se trata de un estudio cualitativo envolviendo 34 profesionales de la salud de las diferentes categorías. Los resultados del estudio mostraron que la escasez de información, la falta de objetividad, integridad y claridad en la transferencia del conocimiento favorece la ruptura de la prestación de servicios de calidad. La comunicación organizacional es un instrumento eficaz para respaldar los cambios importantes en las empresas, como es el alcance de la acreditación hospitalaria. Al correlacionar el cambio de forma concisa y clara, con lo que se refiere a la comunicación, se puede lograr estándares de calidad perenne.

Implementación de 9 indicadores de calidad en un laboratorio hospitalario / Implementation of nine quality indicators in a hospital emergency clinical laboratory

Background: Quality indicators are tools used to monitor specific activities within a process and improve it. In the area of clinical laboratories, the National Accreditation Standards for Providers of Health and the ISO 15189 standard recommend the implementation of indicators that monitor the test cycle with emphasis on those that contribute to a safer health care. Aim: To describe the implementation of nine indicators in a hospital clinical laboratory and their measurement during one year. Material and Methods: The indicators implemented and measured were four of the pre-analytical phase (number of rejected samples, times of transport, blood culture contamination and blood cultures inoculated with adequate blood volumes), two of the analytical phase (coherence of Gram stains of blood culture with microorganism cultured and correct results in external quality control surveys) and three of the post-analytical phase (compliance with order to report lapse goals, corrected reports and alert values report). Results: Two indicators of pre-analytical phase did not meet the per determined targets: number of rejected samples and blood cultures inoculated with adequate blood volume. All indicators of the analytical and post analytical phases were within thepre-determined targets. Conclusions: Coordinated work should be initiated especially with the nursing service to correct the two indicators that did not meet the target. The incorporation of quality indicators to monitor critical processes within the laboratory was undoubtedly an opportunity to identify areas for improvement.

A mudança organizacional em um estabelecimento de saúde: um estudo da preparação para acreditação / Organizational change in a health facility: a study of the preparation for accreditation

Esse estudo teve por objetivo analisar as dinâmicas de mudanças organizacionais transcorridas em um estabelecimento de saúde. Conduzido através metodologia de estudo decaso descritivo, teve como campo de pesquisa o Instituto de Hematologia do Estado do Rio de Janeiro. Buscando conhecer o papel da preparação para acreditação na dinâmica da mudançaem uma organização de saúde essa pesquisa foi assim estruturada: abordagem dos problemasencontrados nas mudanças organizacionais em estabelecimentos de saúde; quadro teórico estruturado com uma revisão de literatura; embasamento da metodologia aplicada, com definição de instrumentos de coletas de dados, de material e atores implicados no levantamento para realização da análise qualitativa. O estudo analisou as seguintes variáveis: a natureza da mudança focalizando a extensão, ritmo e trajetória; as estratégias de ação,contemplando as situações de adesões e resistência e a concepção, verificando se as mudanças foram indutivas ou dedutivas. O resultado demonstrou que a preparação para acreditação naquele hospital, proporcionou mudanças com movimentos lentos, mas com continuidade em todos os setores do estabelecimento. Foi identificada participação mais ativa de um grupo deprofissionais identificados como facilitadores, funcionando como multiplicadores. A abrangência das estratégias aplicadas foram desde as reuniões em assembléias gerais, áformação de grupos de estudo por setores para entendimento do manual de padrões de acreditação. Foram realizados processos internos de auto-avaliação com base no manual deacreditação. Em relação á concepção, o processo de mudança foi motivado pela determinação da direção do hospital para obtenção do certificado de acreditação internacional. Quanto áresistência e adesão, o estudo demonstrou que a participação de uma grande maioria dos profissionais foi motivada pelo desejo de aprender e desenvolver novas práticas queproporcionasse a melhoria da qualidade da assistência...

Ethics committees and clinical trials registration in India: opportunities, obligations, challenges and solutions.

Registering clinical trials is considered an ethical and moral imperative. The launch of the Clinical Trials Registry-India provides opportunities to all in India to fulfil this imperative. The CTRI requires prospective registration, disclosure of all 20 items in the WHO Trial Registration Data Set and proof of ethics and regulatory clearances. Registration in the CTRI is voluntary. However, institutional research ethics committees have obligations. This article reviews these obligations and provides an example of how this can be achieved.

Development of Standards and Criteria for Accreditation of a Baccalaureate Nursing Education Program: Reflections on the Unique Characteristics of the Nursing Profession / 간호학회지

PURPOSE: The purpose of this study was to determine characteristics of nursing science and identify expected outcomes from baccalaureate graduates, and to develop accreditation standards and criteria reflecting the characteristics of the nursing profession. METHODS: A methodological research design was utilized in this study. Related literature reviews and the nursing education program goals and objectives of the 99 nursing schools in Korea were analyzed. A cross-sectional survey research design was utilized to test the validity of the developed characteristics of the nursing profession and their accreditation criteria and standards. The face validity was from the advisory committee and public committee hearing. RESULTS: The characteristics of nursing science were defined with five concepts including humanity, scientific knowledge, professionalism, therapeutic relationship, and facilitating well-being. The expected outcomes from graduates were identified as providing holistic nursing, critical thinking, establishing professionalism and leadership, construction of a therapeutic relationship, and skilled nursing practice. Finally6 standards and 14 criteria reflecting the unique characteristics of the nursing profession were developed for accreditation. These proposed accreditation standards and criteria are a challenge to promote the quality of nursing science.

Evaluación de la calidad de los servicios y de la atención ofertada por el Hospital Aquilino Tejeira de Penonomé, en el Año 2005, mediante la verificación del cumplimiento de los estándares de acreditación de hospitales del Ministerio de Salud de Panamá / Evaluation of the quality of the services and of the atention offered by the Hospital Aquilino Tejeira de Penonomé in the Year 2005, by means of the verification of the fulfillment of the hospitals accreditation standards of the Ministerio de Salud d

Se realizó un estudio con el objeto de evaluar la calidad de los servicios y de la atención ofertada por el Hospital Aquilino Tejeira de Penonomé en el año 2005, mediante la verificación del cumplimiento del nivel 1 de los 32 Estándares Obligatorios de Acreditación de Hospitales del Ministerio de Salud. La evaluación se realizó aplicando un encuesta que incluyó la entrevista con las jefaturas de servicios médicos, técnicos y administradores y la inspección. Los resultados obtenidos indican que el Hospital Aquilino Tejeira cumple con 23 de los 32 estándares obligatorios, cifra que representa el 71.87 (por ciento) de cumplimiento. De con lo establecido en el marco metodológico de este estudio, el Hospital no acredita, ya que es necesario aprobar un 80.0 (por ciento) de los mismos para establecer que los servicios y la atención de este hospital, tiene un nivel óptimo de calidad. El análisis de la información obtenida indica que los estándares que evalúan la Organización Médica e Instalaciones, son el factor principal de que el Hospital Aquilino Tejeira de Penonomé, no alcance el porcentaje de cumplimiento establecido para acreditar. Este resultado conduce a proponer al equipo gerencial de este Hospital, que se realicen acciones que consoliden los Programas de Garantía de Calidad, Prevención, Vigilancia y Control de Infecciones Nosocomiales, Seguridad General, Salud Ocupacional, Gestión y Manejo de Desechos Hospitalarios Peligrosos y Derivaciones, que son soporte fundamental para los servicios finales del hospital y para generar una cultura de calidad.

Situation analysis of occupational and environmental health laboratory accreditation in Thailand.

The objective of this study was to analyze the current situation of laboratory accreditation (LA) in Thailand, especially on occupational and environmental health. The study integrated both quantitative and qualitative approaches. The response rate of the quantitative questionnaires was 54.5% (226/415). The majority of the responders was environmental laboratories located outside hospital and did not have proficiency testing. The majority used ISO 9000, ISO/IEC 17025 or ISO/ EEC Guide 25, and hospital accreditation (HA) as their quality system. However, only 30 laboratories were currently accredited by one of these systems. Qualitative research revealed that international standard for laboratory accreditation for both testing laboratory and calibration laboratory was ISO/IEC Guide 25, which has been currently revised to be ISO/IEC 17025. The National Accreditation Council (NAC) has authorized 2 organizations as Accreditation Bodies (ABs) for LA: Thai Industrial Standards Institute, Ministry of Industry, and Bureau of Laboratory Quality Standards, Department of Medical Sciences, Ministry of Public Health. Regarding LA in HA, HA considered clinical laboratory as only 1 of 31 items for accreditation. Obtaining HA might satisfy the hospital director and his management team, and hence might actually be one of the obstacles for the hospital to further improve their laboratory quality system and apply for ISO/IEC 17025 which was more technically oriented. On the other hand, HA may be viewed as a good start or even a pre-requisite for laboratories in the hospitals to further improve their quality towards ISO/IEC 17025. Interviewing the director of NAC and some key men in some large laboratories revealed several major problems of Thailand's LA. Both Thai Industrial Standards Institute and Bureau of Laboratory Quality Standards did not yet obtain Mutual Recognition Agreement (MRA) with other international ABs. Several governmental bodies had their own standards and accreditation systems, and did not accept other bodies' standards and systems. This put a burden to private laboratories because they had to apply and get accredited from several governmental bodies, but still had to apply and get accredited from international ABs especially for those dealing with exports. There were only few calibration laboratories, not enough for supporting the calibration required for the equipment in testing laboratories' LA. Purchasing proficiency testing specimens from abroad was very expensive, and often got into troubles with the customs duty procedures. The authors recommend some strategies and activities to improve laboratory accreditation in Thailand. Improvement in occupational and environmental health laboratories would essentially be beneficial to laboratory accreditation of other areas such as clinical laboratory.

Overview of the laboratory accreditation programme of the College of American Pathologists

Although Saudi medical laboratories have developed enormously over the past 25 years, the absence of a national body for medical laboratory accreditation has meant the number of accredited laboratories [seven] remains low. Of these, five are accredited by the College of American Pathologists' Laboratory Accreditation Program [LAP]-the 'gold standard' of laboratory accreditation. It requires successful performance in the College of American Pathologists' proficiency testing programme as well as passing on-site inspections carried out by practising laboratory technicians, after which the laboratory is accredited for a 2-year period. This article gives an insight into the current situation of laboratory accreditation in Saudi Arabia and an updated overview of the process involved in obtaining laboratory accreditation from the College of American Pathologists

La autoevaluación dentro del proceso de acreditación del Programa de Enfermería de la Universidad de La Sabana / The autoevaluación within the process of accreditation of the Nursing Program at La Sabana University

La autoevaluación y la autorregulación sirven para determinar el funcionamiento y los logros del programa, que se revierten en la capacidad de retroalimentar su funcionamiento y procurar su excelencia, cuyo fin es demostrar que el programa que se somete a la acreditación tiene calidad, la cual es verificada por pares externos a la institución o programa.El Programa de Enfermería de la Universidad de La Sabana, desde el inicio de sus actividades, ha realizado autoevaluaciones que le han servido para mejorar sus procesos y retroalimentar sus acciones en la formación de estudiantes y profesores. No ajena a lo determinado por la Ley, se inscribió en el proceso de acreditación, y para tal fin, siguiendo los lineamientos dados por la Dirección de Acreditación y Currículo, realizó una autoevaluación del programa en los diez factores propuestos por el CNA; analizó cada una de las 66 características y las 200 variables, y emitió juicios basados en documentos de análisis y soporte y en encuestas de opinión aplicadas a estudiantes, profesores, directivos y egresados, acerca de la realidad académica y administrativa, lo cual permitió determinar las fortalezas y debilidades y proponer planes de mejoramiento en el fortalecimiento del programa

Hospital accreditation in Latin America

Durante la decada de los 80 se produjo un notable deterioro de la infraestructura fisica y de la operatividad de los hospitales de America Latina como consecuencia de la crisis economica que sufrieron casi todos los paises de la Region y de las politicas sanitarias que pusieron el enfasis en la prevencion de las enfermedades y en la promocion de la salud, en detrimento de la asistencia hospitalaria. Como reaccion a esta situacion y con el apoyo de la Organizacion Panamericana de la Salud, muchos paises de America Latina iniciaron en la decada de los 90 esfuerzos para implementar la acreditacion de los hospitales, con el fin de establecer estandares de calidad para todos los servicios de cuidados agudos de los hospitales generales. Durante la ultima decada, diversos paises de America Latina han hecho avances en la puesta en practica de esos programas de acreditacion. Este articulo presenta las lecciones aprendidas como resultado de esas experiencias y expone el caso de Brasil como ejemplo de los pasos mas importantes que debe dar un pais al planificar y poner en practica un programa de acreditacion de hospitales

El nuevo rostro de la calidad en la Universidad Mayor de San Andrés / The new quality y face in the San Andres University

La Universidad Mayor de San Andrés ha comenzado hace 5 años un proceso de evaluación académica: Autoevaluación y Evaluación y Acreditación Externa. Este cambio irreversible tiene diferentes grados de avance en las diversas facultadades de la Universidad, y se ha realizado con diversas caracteristicas. En este trabajo se presenta el estado actual de avance del proceso, con detalle respecto a las particularidades en cada facultad.

En busca de la calidad y la excelencia en la facultad de medicina, enfermeria, nutricion y tecnologia médica de la UMSA / In search of the quality and excelence in the medicine faculty, nursery, nutrition and medical technology, San andres University

Se presenta el documento resumino del trabajo realizado durante el proceso completo de evaluación de la Faucltad de Medicina de la Universidad Mayor de San Andrés, que comenzó con la evaluación interna y que culminó con la acreditación por pares académicos internacionales. También se muestran aquellos datos más relevantes que, a juicio de la autora, resultaron en el éxito de este proceso, el primero de su tipopara cualquier facultad de una Universidad Boliviana.