[The interplay between isolation and precariousness, and hospitalization duration in French Guiana]. / Calcul de l'IP-DMS en Guyane : prendre en compte le poids réel de la précarité et de l'isolement.

BACKGROUND: French Guiana faces singular health challenges: poverty, isolation, structural lag, difficulties in attracting health professionals. Hospital stays exceed the recommended durations. The present study aimed to model the impact of precariousness and geographic isolation on the hospital duration performance indicator and to recalculate the indicator after incrementing severity by 1 unit when patients were socially precarious. METHODS: Cayenne hospital data for 2017 were used to model the hospital duration performance indicator (IP-DMS) using quantile regression to study the impact of geographic and social explanatory variables. This indicator was computed hypothesizing a 1 unit increment of severity for precarious patients and by excluding patients from isolated regions. RESULTS: Most excess hospitalization days were linked to precariousness: the sojourns of precarious patients represented 47% of activity but generated 71% of excess days in hospital. Quantile regression models showed that after adjustment for potential confounders, patients from western French Guiana and Eastern French Guiana, precarious patients and the interactions terms between residence location and precariousness were significantly associated with IP-DMS increases. Recalculating the IP-DMSafter exclusion of patients from the interior and after increasing severity by 1 notch if the patient was precarious led to IP-DMS levels close to 1. CONCLUSION: The results show the nonlinear relationship between the IP-DMS and geographical isolation, poverty, and their interaction. These contextual variables must be taken into account when choosing the target IP-DMS value for French Guiana, which conditions funding and number of hospital beds allowed in a context of rapid demographic growth.

Percepção de enfermeiros sobre utilização do protocolo do sistema de classificação de risco Manchester / Nurses perception on the use of the Manchester risk classification system protocol

O estudo teve como objetivo analisar a percepção de enfermeiros sobre o protocolo do sistema de Classificação de Risco Manchester. Pesquisa qualitativa descritiva, realizada em outubro de 2012, por meio de entrevistas semiestruturadas com 15 enfermeiros do Serviço de Emergência de um hospital universitário da região sul do Brasil. Os dados foram submetidos à análise temática. Os resultados indicam que o protocolo do Sistema de Classificação de risco de Manchester padroniza a conduta dos profissionais, conferindo segurança para priorizar o risco de usuários que buscam atendimento em serviços de emergência. Além disso, propicia respaldo legal aos profissionais, baseando-se em critérios objetivos e previamente definidos. As dificuldades apontadas para a realização da atividade foram: o desconhecimento da população sobre o protocolo, a precariedade do fluxo de encaminhamento para a rede de serviços de saúde e a resistência da equipe médica a um trabalho conjunto. Conclui-se que a utilização do protocolo do sistema de classificação de Manchester propiciou melhoria na organização do fluxo de usuários no serviço de emergência e na qualidade do atendimento prestado.

The study aimed to analyze the perceptions of nurses regarding the Manchester Risk Classification System Protocol. It is a qualitative descriptive research, accomplished in October 2012, by means of semi-structured interviews with 15 emergency service nurses of a university hospital in southern Brazil. The data were submitted to a thematic analysis. The results indicate that the Manchester Risk Classification System Protocol standardizes the conduct of professionals, giving security to prioritize the risk of users who seek care at emergency services. In addition, it provides legal support to professionals, based on objective and previously defined criteria. The pointed out difficulties for the accomplishment of the activity were: the unawareness of the population about the Protocol, the precariousness of the stream of referrals to the network of health services and medical staff resistance to joint work. It is concluded that the use of the Manchester Risk Classification System Protocol led to improvement in organizing the flow of users in emergency services and in the quality of the provided service.

Taking care: a manual for medical office administrators

THe manual sets out to pinpoint common areas of language and management deficiencies affecting day-to-day performances, and to correct them by a variety of methods. These include questions, comprehension exercises, word tests, pronunciation drills, vocabulary building and specific exercises on procedure. A dictionary is a basic tool to have among reference documents in your office as a companion to this manual (AU)