Thèses : « Hospital activity »

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Steele, Patrick W. « Physical activity counseling through Registered Nurses in a hospital setting ». Thesis, Kansas State University, 2014. http://hdl.handle.net/2097/17544.

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Master of Public Health
Department of Kinesiology
Mary McElroy
Background and Purpose: Registered nurses (RN’s) are well positioned to provide physical activity counseling (PA counseling) to their hospital patients. RNs educate during ‘teachable moments” as hospital patients often find themselves in a state of readiness to make lifestyle changes such as increases in regular physical activity. Although the health benefits of physical activity are well documented, PA counseling has not been well studied among the nursing population or in the hospital environment. The main purpose of this study was to identify the percentage of RNs who provide PA counseling to their patients and to explore the factors which contribute to their decisions to provide PA counseling. Methods: A web-based survey was used to gather information from 323 hospital-based RNs employed at five hospitals in four states. The survey gathered information including current physical activity levels, thirteen perceived barriers to physical activity based on the Exercise Benefits and Barriers Scale, and information regarding whether RNs provide PA counseling to their hospital-based patients. Results: RNs reported an average of 3.3 barriers to being physically active. One hundred and eighty- seven RNs provided PA counseling to their patients (57.8%) and 133 did not provide PA counseling (41.1%). The presence of barriers to being physically active was related to PA counseling for nine of the thirteen barriers. The following hypotheses were supported: 1) RNs who report lower levels of perceived barriers to being physical active were more likely to provide PA counseling than those who report higher levels of perceived vigorous physical activity were more likely to provide PA counseling than those who reported lower levels of light, moderate, and vigorous physical activity. Conclusion: The findings from this study revealed RNs who are physically active and report fewer barriers to physical activity were more likely to provide PA counseling to their hospital-based patients. Future research needs to address types and quality of PA counseling as well as utilize theory driven intervention designs.

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Botelho, Ernani Mendes. « Custeio baseado em atividades - ABC : uma aplicação em uma organização hospitalar universitária ». Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/12/12139/tde-10042008-102523/.

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O desenvolvimento do Sistema ABC (Activity-Based Costing/Sistema de Custeio Baseado em Atividades) e sua aplicação em organizações industriais apresentou-se como uma importante ferramenta no processo de gerenciamento das organizações. A viabilidade deste sistema em organizações industriais e a carência de um sistema que apoiasse o processo de gerenciamento em organizações hospitalares despertaram, na área acadêmica, o desenvolvimento de trabalhos científicos que objetivam discutir a viabilidade da aplicação deste sistema também nas organizações hospitalares. A pesquisa bibliográfica deste trabalho demonstrou a existência de muitos trabalhos acadêmicos abordando a aplicação deste sistema em organizações hospitalares, sendo, no entanto, que todos estes abordam a aplicação em setores isolados. Visando ampliar a discussão a respeito deste tema, procurando discutir como seria a aplicação do mesmo sistema em uma organização hospitalar como um todo, este trabalho teve como objetivo geral delinear um modelo a partir da identificação e integração de dados, baseado na concepção do sistema ABC, que seja aplicável às organizações hospitalares. Para atingir este objetivo, foi aplicado um estudo empírico no Hospital Universitário Clemente de Faria em todos os seus setores e clínicas. Os resultados revelaram que o Sistema ABC pode ser aplicado em qualquer tipo de organização hospitalar, seja esta pública, privada ou filantrópica, devendo-se apenas realizar algumas adaptações conforme as características de cada organização.
The viability of the ABC System (Activity-Based Costing) in industrial organizations has led to the academic area to investigate the viability of the application of this system also in hospital organizations. However the studies developed in Hospitals approach the application of this system in isolated sections. Enlarging the discussion concerning to this topic, this work had the purpose of delineating a model starting from the identification and integration of data basing on the conception of ABC system that would be applicable to hospital organizations in a generalized way. In order to reach to this objective, an empirical study was developed in all sections of the Hospital Universitário Clemente de Faria. With the study it was possible to delineate a model applicable to the studied institution. It is understood that this model is applicable to any kind of organization - public, private or philanthropic -, provided that some adaptations are done according to the characteristics of each organization.

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Bloor, Karen Elizabeth. « Reward and activity of hospital consultants in the National Health Service ». Thesis, University of York, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.423756.

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Ngarambe, Robert. « Physical activity levels and health promotion strategies among physiotherapists in Rwanda ». Thesis, University of the Western Cape, 2011. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_5969_1367481268.

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Physical inactivity has become a global health concern and is among the 10 leading causes of death and disability. This has led to increased concern for chronic diseases of lifestyle (CDL).
Studies have revealed that regular physical activity is effective in combating several CDL such as cardiovascular disease, diabetes, cancer, hypertension and obesity. Physiotherapists are in a
position to combat inactivity and effectively promote physical activity to their clients. Studies however have shown that participation in physical activity among physiotherapists could have an
impact on the promotion of physical activity and their health practices. This study therefore sought to establish the relationship between physical activity levels of physiotherapists and their
physical
activity promotion strategies and barriers to promoting physical activity. Sequential Mixed Method Design was used in this study. Data was collected by means of a self administered
questionnaire and a total of 92 physiotherapists voluntarily answered the questionnaire. A focus group discussion comprising of 10 purposively selected physiotherapists was conducted. The
questionnaire assessed physical activity levels
and physical activity promoting strategies of the participants while the focus groupdiscussion looked at the barriers to promoting physical
activity. The Statistical Packages for Social Sciences (SPSS) version 18 was used for data capturing and analysis. Descriptive statistics were employed to summarize demographic information
as means, standard deviation, frequencies and percentages. Inferential statistics (chi-square) was used to test the associations between different categorical variables (p<
0.05). For the qualitative data, focus group discussions were used to collect data. Tape recorded interviews were transcribed verbatim, field notes typed, sorting and arranging data was done and themes

were generated. Thematic analysis was then done under the generated themes. Ethical issues pertaining to informed consent, anonymity, confidentiality and the right to withdraw from the
study were respected in this current study. The findings in the current study revealed that a big number of the participants were physical active both at work and recreation domains. However,
there was no statistically significant association between physical activity and the demographicvariables. The results in this study revealed that the majority of participants were good
physical activity promoting practices, although there was no significant association between physical activity levels and the physical activity promoting practices. The finding in this study revealed that discussing physical
activity and giving out information regarding physical activity to their clients were the most common methods used in promoting physical activity. However, participants also highlighted barriers they
ace in promotion of physical activity such as policies on physical activity, cultural influence, nature of work, time management as well as environmental barriers. The study demonstrates the
need for all stakeholders to come up with solutions to break the barriers to promotion of physical activity. In return it will bring about enormous health
benefits to the general population.

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Sheridan, Jeanette. « Activity Based Funding : The implications for Australian health policy ». Thesis, The University of Sydney, 2016. http://hdl.handle.net/2123/15763.

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This thesis answers the question: Has the throughput of patients in public hospitals changed since the introduction of Activity Based Funding? A multi-case study of one New South Wales Metropolitan and one Regional Local Health District, was conducted. Hospital admissions and visits to Emergency Departments of patients with chronic diseases, are analysed over the period 2009 to 2013. Changes in patient throughput are identified, and seven possible explanations for these changes, such as a change in demography of patients or a change in clinical practice, are explored. An index (the PARI) was developed from which the potential revenue and resource implications for each clinical condition, in each hospital, in each Local Health District, are examined. The findings from this study are discussed within the theoretical framework of Alford’s (1974) structure interests at three levels: first, the micro level (public hospitals and patient care); second, the meso level (public health policy for publicly-owned and operated health services); and third, the macro level (the role of the state vis-à-vis capital accumulation, interest groups and the global health market)«br /» «br /» It is concluded that, many patients who were ‘eligible’ to be treated in a setting other than that of an inpatient, were admitted to hospital for their treatment. Activity Based Funding has, however resulted in patients spending fewer days in hospital. The implications of these findings are that: (i) the ‘bio-medical’ model of the provision of health care will continue, and the interest of current interest groups preserved; (ii) the increasing amounts of public expenditure to the private sector, means less funding is available for publicly-owned and operated health services; and (iii) more of the cost of health care is being passed from the taxpayer to the consumer. The greatest change in dominant interests, since the work of Alford, is the growing influence of multi-national companies that supply health-related goods and infrastructure globally, which hinders the development of a competitively strong domestic industry.

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Battaglia, Tatiana <1994&gt. « HEALTHCARE COST ACCOUNTING : A COMPARISON BETWEEN ACTIVITY BASED COSTING AND TIME DRIVEN ACTIVITY-BASED COSTING IN THE UNIVERSITY HOSPITAL ». Master's Degree Thesis, Università Ca' Foscari Venezia, 2019. http://hdl.handle.net/10579/15316.

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This Thesis analyse how the Cost Accounting process has evolved in time and how it has been applied to the National Healthcare System, studying the different cost methods. The first two chapters have a theorical approach regarding cost accounting techniques, in particular there is a comparison between Activity Based Costing and Time Driven Activity-Based Costing. The third chapter contains an empyrical analysis of a surgical procedure in the Department of Surgical, Oncological and Gastroenterological Sciences of the University Hospital of Padua.

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Lela, Mukaruzima. « The relationship between physical activity and low back pain among nurses in Kanombe Military Hospital ». Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_3554_1307534535.

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The aim of the current study was to determine the relationship between low back pain and physical activity levels among nurses in Kanombe Military Hospital (KMH), as well as other confounding factors leading to low back pain. A quantitative, cross-sectional and descriptive design was used to conduct the study. The study population and sample included all clinical nurses in all the departments/wards at KMH (excluding three nurses doing administrative work only and the four who participated in the pilot study). A total of 133 nurses participated in the study and data was collected using three self administered questionnaires. The first one requested socio-demographic data, followed by the International Physical Activity Questionnaire (IPAQ) which examined the physical activity levels of nurses, and lastly the Nordic Musculoskeletal Disorder Questionnaire which examined low back pain prevalence. A response rate of 122 (92%) was obtained.

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Kern, Anja. « The use of key figures and its impact on activity : the case of a hospital ». Frankfurt, M. Berlin Bern Bruxelles New York, NY Oxford Wien Lang, 2006. http://d-nb.info/987949489/04.

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McCully, William Francis. « The antibacterial activity of tea infusions and their effect against the hospital pathogen clostridium difficile ». Thesis, Cardiff University, 2013. http://orca.cf.ac.uk/52337/.

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Clostridium difficile is one of the UK’s most common hospital acquired infections and there is anecdotal evidence to suggest that the bacteria are sensitive to the antibacterial properties of tea. Surprisingly, little research has been undertaken to characterise the inhibitory activity of aqueous tea infusions that are representative of traditional drinking habits. The antibacterial properties of tea are thought to be due to a group of polyphenols called catechins. However, their contribution to the inhibitory activity of tea infusions and their mechanism of action is still subject to debate. An antimicrobial assay, developed using Staphylococcus aureus as a model organism, was used to determine the antibacterial activity of a range of tea infusions against 75 clinical isolates of C. difficile that represented all the major strain ribotypes over 11 years. Green teas demonstrated more potent antibacterial activity than black teas and their activity was positively correlated with antioxidant power, hydrogen peroxide production, and catechin content. Furthermore, the country of origin of the tea affected the catechin content and subsequent antimicrobial activity of the infusion. Detailed chemical analysis using high performance liquid chromatography and counter current chromatography suggests that the antibacterial activity of tea is probably the result of synergistic interactions between a number of catechins rather than the activity of an individual compound. With regards to the mode of action by which tea inhibits C. difficile, electron microscopy studies of the bacterium treated with green tea revealed distinct changes to the outer cell structures of the bacteria. These changes were indicative of cell membrane blebbing, thus supporting the theory that tea compounds interact with the bacterial membrane and/or cell wall. Overall, this investigation concluded that tea infusions have inhibitory activity against C. difficile in vitro and may be useful in the treatment or prevention of C. difficile infections in vivo.

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Meshe, Oluwasomi F. « Physical activity, health status and hospital admission in chronic obstructive pulmonary disease following pulmonary rehabilitation ». Thesis, Anglia Ruskin University, 2018. http://arro.anglia.ac.uk/703781/.

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Background: Despite the several benefits of post-rehabilitation Community-based Exercise Programmes (CEPs) to people with COPD, it is unclear whether these patients objectively improve their levels of daily physical activity (PA) and whether this is associated with improvement in other clinical outcomes. Methods: A mixed-methods sequential explanatory study design was applied. Daily PA (accelerometers, model AM300), health status (Saint George’s Respiratory Questionnaire, SGRQ), exercise capacity (6MWD testing), pulmonary functional, FEV1 (spirometry) and number of hospital admission (self-reporting) were measured at time points 1 (start of study) and 2 (after 3 months) of a CEP in 26 participants with COPD (mean [±SD] age, 73±7 years; FEV1, 64±19% predicted). Participants’ views of the benefits, barriers and enablers of participation were also explored. Results: Levels of daily PA improved moderately (42 minutes/day on moderate-intensity PA) but not significantly. Health status, 6MWD and FEV1 improved while hospital admission reduced significantly after 3 months (all p< 0.05). Daily PA correlated positively with 6MWD (r = 0.40, p=0.046) and negatively with health status (r= -0.52, p=0.006) and number of hospital admission (r= -0.394, p<0.05). Changes in levels of daily PA correlated positively with changes in 6MWD (r= 0.31, p= 0.048) and negatively with changes in health status (r= -0.65, p= 0.0001). Only health status significantly predicted levels of daily PA (Beta= -0.47, t= -2.85, p=0.009, R2adjusted= 0.38). These results were enabled by six factors; ease of access to PA intervention, convenient programme components, being retired, feeling safe, social support and seasons. Four barriers to activity participation were identified; poor physical health, family commitments, transport difficulties and other commitments. Conclusion: Moderate improvement in levels of daily PA produced by a CEP is associated with improvements in clinical outcomes in people with COPD. Strengthening enablers of adherence to the programme is important to achieving the goals of COPD management.

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Meshe, Oluwasomi F. « Physical activity, health status and hospital admission in chronic obstructive pulmonary disease following pulmonary rehabilitation ». Thesis, Anglia Ruskin University, 2018. https://arro.anglia.ac.uk/id/eprint/703781/1/Meshe_2018.pdf.

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Background: Despite the several benefits of post-rehabilitation Community-based Exercise Programmes (CEPs) to people with COPD, it is unclear whether these patients objectively improve their levels of daily physical activity (PA) and whether this is associated with improvement in other clinical outcomes. Methods: A mixed-methods sequential explanatory study design was applied. Daily PA (accelerometers, model AM300), health status (Saint George’s Respiratory Questionnaire, SGRQ), exercise capacity (6MWD testing), pulmonary functional, FEV1 (spirometry) and number of hospital admission (self-reporting) were measured at time points 1 (start of study) and 2 (after 3 months) of a CEP in 26 participants with COPD (mean [±SD] age, 73±7 years; FEV1, 64±19% predicted). Participants’ views of the benefits, barriers and enablers of participation were also explored. Results: Levels of daily PA improved moderately (42 minutes/day on moderate-intensity PA) but not significantly. Health status, 6MWD and FEV1 improved while hospital admission reduced significantly after 3 months (all p< 0.05). Daily PA correlated positively with 6MWD (r = 0.40, p=0.046) and negatively with health status (r= -0.52, p=0.006) and number of hospital admission (r= -0.394, p<0.05). Changes in levels of daily PA correlated positively with changes in 6MWD (r= 0.31, p= 0.048) and negatively with changes in health status (r= -0.65, p= 0.0001). Only health status significantly predicted levels of daily PA (Beta= -0.47, t= -2.85, p=0.009, R2adjusted= 0.38). These results were enabled by six factors; ease of access to PA intervention, convenient programme components, being retired, feeling safe, social support and seasons. Four barriers to activity participation were identified; poor physical health, family commitments, transport difficulties and other commitments. Conclusion: Moderate improvement in levels of daily PA produced by a CEP is associated with improvements in clinical outcomes in people with COPD. Strengthening enablers of adherence to the programme is important to achieving the goals of COPD management.

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Leal, Edvalda Araújo. « Análise de custos no setor hospitalar - utilização da metodolologia Activity Based Costing - ABC : O Caso das Cirurgias Cardíacas no Hospital Universitário de Uberlândia ». Pontifícia Universidade Católica de São Paulo, 2006. https://tede2.pucsp.br/handle/handle/1654.

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Made available in DSpace on 2016-04-25T18:40:21Z (GMT). No. of bitstreams: 1 CCA - Edvalda Araujo Leal.pdf: 858508 bytes, checksum: 7e2325b584a317267860440a0d8b2197 (MD5) Previous issue date: 2006-11-22
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The productive process in teaching hospitals is expensive due to the fact that it incorporates teaching activities, research and extension which make thee hospitals a reference for cutting edge technology. They also need to attend to the requirements established by new paradigms in society. Considering this challenge and the complexity of these organizations, it is essential to use cost methods that are able to reduce the level of uncertainty in deciding processes. This work presents an analysis of feasibility for applying cost activity methodology in the costs of a teaching hospital entity which is limited, in this study, to the heart surgery specialty. The research strategy used was the case study accomplished in the Surgical Centre of the Clinical Hospital of Uberlândia (HCU), in the last trimester of 2005. The development was conducted based on process analysis, identification of involved resources and the cost directives to the activities involved. After being defined the resources and their participation, the next phase tries to verify in which way the resources are used by the activities during the operation. After the process analysis, the activities are identified and a resource directive, which measures the activity use during surgeries, is established. The results indicate that the ABC offers detailing levels of the process of higher hospital services than those in the traditional cost systems. It is then possible to best perceive the use of resources during an operation and, therefore, calculate the cost of a major surgery more accurately. This work confirms the feasibility of the ABC cost methodology in the hospital segment, respecting its peculiarities of application, its philosophy, principles and methodology, analyzing the specific data of the HCU. The aim is to be able to measure more precisely the costs and improve hospital management
O processo produtivo dos hospitais de ensino é dispendioso, haja vista que incorpora atividades de ensino, pesquisa e extensão que os tornem um referencial em tecnologia de ponta, além de necessitarem acompanhar as exigências estabelecidas pelos novos paradigmas da sociedade. Frente a esse desafio, e considerando a complexidade dessas organizações, torna-se fundamental o uso de métodos de custos que consigam reduzir o nível de incerteza dos processos decisórios. Este trabalho apresenta uma análise da viabilidade da aplicação da metodologia de custeio em atividades nos custos de uma entidade hospitalar de ensino - delimitado, neste estudo, à especialidade de cirurgias cardíacas. A estratégia de pesquisa utilizada é o estudo de caso realizado no Centro Cirúrgico do Hospital de Clínicas de Uberlândia (HCU), no último trimestre de 2005. O desenvolvimento parte da análise dos processos, identificação dos recursos envolvidos e os direcionadores de custos às atividades envolvidas. Definidos os recursos e sua participação, a fase seguinte busca verificar em que medida os recursos são empregados pelas atividades durante o procedimento cirúrgico. A partir da análise de processos, as atividades são identificadas, e estabelecido um direcionador de recursos que mensure o uso da atividade durante as cirurgias. Os resultados indicam que o ABC oferece níveis de detalhamento do processo de prestação de serviço hospitalar mais elevados do que nos sistemas tradicionais de custos e consegue-se perceber melhor o uso dos recursos durante o procedimento cirúrgico, em conseqüência, auferindo o custo da cirurgia por porte com maior precisão.O presente trabalho confirma a viabilidade da metodologia do custeio ABC no segmento hospitalar, respeitando suas peculiaridades de aplicação, sua filosofia, princípios e metodologia, analisando os dados específicos do HCU, visando à mensuração mais adequada dos custos e melhor gerenciamento hospitalar

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Isah, Esther Ebole. « Physicians‟ information practices : a case study of a medical team at a Teaching Hospital ». Doctoral thesis, Högskolan i Borås, Institutionen Biblioteks- och informationsvetenskap / Bibliotekshögskolan, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-3630.

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This thesis is a user study within library and information science on participatory practices of a professional group in work activity. This has been investigated only to a minor extent in previous library and information science research. The qualitative empirical focus alternates between physicians‟ engagements in work practice and workplace learning within patient care. The overall research problem was to learn how people in workplaces interacted with information that was embedded, intricately intertwined, and tightly bound to the ongoing routines of their everyday work. This thesis aims at understanding information practices of professionals in occupational settings as exemplified by a team of physicians in a Nigerian teaching hospital. In this thesis, the focus was on the collective work activity, and the specific goals identified include how physicians interact and make meaning in the context of the social activities in the workplace, how professionals individually or collectively gather, understand, produce, share and use information, and how workplace learning influences information practices. Information practices are viewed as sociocultural practices that occur inside other practices. The thesis focuses on a nuanced, contextualized understanding of the interplay between the participating actors in activity, the activity per se, and the intermediary role of tools and artefacts. The epistemological point of departure is the sociocultural perspective that emphasizes the dynamic interdependence of the individual with the social and collective development focusing on mediation through tools and artefacts in cultural, institutional, and historical situations. I have chosen cultural-historical activity theory and the practice theories to analyse the dynamic processes in the context of patient care. Their underlying principles guided the empirical study, facilitating extrapolations and illustrations in the analysis. The cultural-historical activity theory was used to understand contextual issues that influence information practices in work activity: the object and subject of activity, division of labour, rules and norms, community, tools and artefacts, as well as the activity system itself and the hierarchical structure of the activity. Theories and concepts employed from a practice perspective on learning were considered useful for understanding the participatory modes in workplace and the influence of social learning communities on diverse information processes. In so doing, the study strives to provide a holistic understanding of information practices, workplace learning, and the relationships between them.The empirical data was gathered through a qualitative case study that lasted over a period of two years. Direct observation was the dominant data collection technique 5 used throughout the preliminary and main empirical studies to capture physicians‟ information practices and experiences. The observation focused on the Clinical Pharmacology and Therapeutics (CPT) team‟s encounters with patients; the interactions they had amongst themselves, and events and situations surrounding patient care. During the main study, other data collection techniques were employed alongside the observation method. In-depth open-ended interviews were conducted with 17 physicians and 9 non-physicians who were selected to provide rich and varied descriptions of the phenomena under study. The interview time totalled at 1,535 minutes. Physical artefacts were another data collection technique employed: 30 patients‟ medical records were assessed during the empirical study. Finally, informal interactions in the research setting were an additional data collection technique used continuously throughout the two empirical periods. The results were analyzed through a combination of inductive and deductive methods of analysis. There are four parts to the empirical results in this thesis. In the first, contextual elements that showed how work environment can be an influencing factor in the information practices of a professional group are described from the perspective of cultural historical activity theory. In the second part, the nature of information access in the real-world information environment was portrayed. It was found that information sources and strategies contributed to the overarching goal of restoring patient health to normalcy. The information sources and strategies were also found useful for mediating the information environment both subjectively and intersubjectively. An equally important result concerns the authority issues related to information sources and strategies. In the third part, available tools and artefacts were presented as useful information aids that also played a mediating role. Tools were categorised into physical tools and language. Language was categorized according to the social situations or classes of speakers. The case notes were seen as useful artefact and occupied a central niche in the studied work activity. These tools and artefacts enabled affordances around which social practices were built on in the work activities. In the last part of the results, various information practices that mirror the participatory practices rather than those of isolated individuals are highlighted. Six dimensions made up and covered the most vital spectrum of the information processing: information gathering, meaning making, information sharing, information use, reading, and documentation. Furthermore, the study revealed that learning took place simultaneously with the work activity and that it influenced information practices at the same time.

Academic dissertation for the Degree of Doctor of Philosophy in Library and Information Science at the University of Borås to be publicly defended on Friday 19 October 2012 at 13.00 in lecture room D 211, University of Borås, Allégatan 1, Borås.

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Althumairi, Arwa Abdulrahman. « Describing the variation in hospital activity following diagnosis with cancer for childhood and adolescent cancer in Yorkshire ». Thesis, University of Leeds, 2016. http://etheses.whiterose.ac.uk/16673/.

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This study aimed to provide a comprehensive assessment of hospital utilisation among children and young people (CYP), addressing recommendations emerging from the Children and Young People’s Health Outcomes Forum that emphasised the importance of improving the health of young people. The burden of care for CYP with cancer on local and national healthcare systems is unknown and lack of data limits the ability to inform and improve service delivery. Therefore, I used a specialist population-based cancer register in CYP from Yorkshire, linked to hospital admissions data, to analyse healthcare utilisation after diagnosis and treatment for cancer. Additionally, clinical and sociodemographic factors that contributed to hospital utilisations during and after treatment were identified and discussed. The study included 3,151 cases of cancer aged 0-29 years diagnosed in Yorkshire during 1996-2009, and admitted to hospital during 1997-2011. The study observed a steady increase in admissions over the period. Children had higher median number of admissions (median=25, Interquartile range (IQR): 8-44) than teenagers and young adults (TYA) (median=10, IQR: 3-20), and spent longer in hospital on average with median duration of three and one days per 100 person-days respectively. However, TYA with leukaemia experienced longer stays in hospital on average than children, with a median duration of eight and four days, respectively. Factors that influenced the pattern of admissions varied by cancer type, however relapse status, type of initial treatment and year of diagnosis were significantly related to hospitalisation independently. Cancer survivors had a significantly higher risk of morbidity compared with the general population after treatment completion (standardised hospitalisation rate (SHR) = 2.37, 95% CI:2.26-2.49). Findings from this work demonstrate the variation in hospital activity by cancer type and age group, as well as the independent predictors of hospitalisation. This aids the continued development of high-quality cancer services to meet the needs of young people with regard to short-term and long-term care.

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Grant, P. Margaret. « A quantification and analysis of the free-living physical activity and sedentary behaviour of older adults in hospital and community settings using body-worn activity monitors ». Thesis, Glasgow Caledonian University, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.547434.

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Introduction: Promoting physical activity and restricting sedentary behaviour have been shown to be important in the prevention and management of chronic health disorders in older adults. Despite this, there is limited objective information concerning the free-living physical activity of older adults, particularly those in hospital. Purpose: This research was designed to investigate the possibility of monitoring the physical activity and sedentary behaviour of older adults (aged:::: 65 years) in hospital with a view to using the technique to explore activity patterns, and, to examine if the technique could be used to evaluate an intervention designed to modifY activity levels. Method: The activPALTM activity monitor was selected to quantifY free-living physical activity. A series of four studies established the criterion related validity and reliability of the monitor as a measure of postural physical activity in healthy adults, community-dwelling older adults and older adults in hospital. The patterns of physical activity and sedentary behaviour of 70 older adults (aged:::: 65 years) in 4 different locations were quantified and described. The groups comprised three patient groups: two from rehabilitation wards (city and rural) and one from a city day hospital; and a healthy community-based group. Subsequently, the measurement technique was used to evaluate the free-living activity of a hospital-based group following an intervention designed to change activity behaviour. ResultslDiscussion: Significant differences in upright time were found between the ward, day hospital and community groups. Differences in the manner in which the groups accumulated upright and sedentary time were found with the ward-based groups sedentary for prolonged periods and upright for very short times. Following the intervention, the measurement technique revealed no difference in mean daily upright time, however, the pattern in which upright time was accumulated did change.

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Afzal, Muhammad. « Modelling temporal aspects of healthcare processes with Ontologies ». Thesis, Jönköping University, JTH, Computer and Electrical Engineering, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-12781.

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This thesis represents the ontological model for the Time Aspects for a Healthcare Organization. It provides information about activities which take place at different interval of time at Ryhov Hospital. These activities are series of actions which may be happen in predefined sequence and at predefined times or may be happen at any time in a General ward or in Emergency ward of a Ryhov Hospital.

For achieving above mentioned objective, our supervisor conducts a workshop at the start of thesis. In this workshop, the domain experts explain the main idea of ward activities. From this workshop; the author got a lot of knowledge about activities and time aspects. After this, the author start literature review for achieving valuable knowledge about ward activities, time aspects and also methodology steps which are essentials for ontological model. After developing ontological model for Time Aspects, our supervisor also conducts a second workshop. In this workshop, the author presents the model for evaluation purpose.

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Pontalti, Gislene. « A sistematização da gestão baseada em atividades (ABM) - Activity Based Management - para aplicação na área hospitalar : caso Centro de Terapia Intensiva de um hospital universitário público ». reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2002. http://hdl.handle.net/10183/1737.

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Esta pesquisa tem por base a aplicação da Gestão Baseada em Atividades ABM - Activity Based Management -, em um Centro de Terapia Intensiva (CTI) de um hospital universitário público. Tem corno objetivo aperfeiçoar a prática gerencial do CTI, estabelecendo relações de causa e efeito no uso dos recursos (humanos, tecnológicos, materiais), permitindo efetuar mudanças para sua melhor utilização, maximizando beneficios a toda organização. O enfoque metodológico foi a pesquisa qualitativa e quantitativa, sendo que o Centro de Terapia Intensiva foi o foco de análise na implementação do ABM. As etapas envolvidas na condução deste trabalho foram a exploratória e a dos seminários, orientadas pela técnica de Thiollent (2000). O trabalho propõe urna sistemática de aplicação do ABM em CTI. A partir de sua aplicação no caso específico - CTI de um hospital público de Porto Alegre - discute os principais benefícios e limitações, bem corno as informações gerenciais proporcionadas. De acordo com análise do conteúdo e os resultados obtidos, pôde-se alicerçar o conhecimento teórico e prático do modelo de gestão proposto, estabelecendo urna nova dimensão na gestão de recursos na área hospitalar, com mais eficiência, assegurando a captura de todo potencial de melhoria identificado.

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FERRARA, PIETRO. « Analysis of hospital activity during the COVID-19 pandemic : population-based evidence from highly impacted provinces in northern Italy ». Doctoral thesis, Università degli Studi di Milano-Bicocca, 2023. https://hdl.handle.net/10281/404613.

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La pandemia da COVID-19, sviluppatasi in Cina alla fine del 2019, ha subito rappresentato la più devastante crisi sanitaria dagli inizi del XX secolo. La rapida trasmissione di SARS-CoV-2 e le restrizioni imposte per tenere sotto controllo il contagio hanno causato interruzioni e ritardi nell’assistenza a condizioni cliniche diverse dal COVID-19 stesso. Al fine di meglio comprendere l’impatto della pandemia sull’assistenza ospedaliera, questa ricerca è andata ad esaminare gli accessi ospedalieri e in pronto soccorso dagli inizi della pandemia (e fino a giugno 2021) nelle province di Bergamo e Brescia, due aree primariamente e duramente colpite durante la prima ondata pandemica tra febbraio e aprile 2020. Sono state condotte analisi longitudinali retrospettive sulle serie storiche degli accessi in ospedale e pronto soccorso, usando il triennio 2017-2019 come riferimento. L’impatto indiretto del COVID-19 sui percorsi assistenziali ospedalieri è stato ulteriormente esaminato attraverso proxy di cura (accessi in ospedale, ricoveri e mortalità) di condizioni cliniche caratterizzate da alti volumi e necessità di assistenza in emergenza-urgenza. Infine, i flussi amministrativi degli eventi che hanno mostrato un eccesso dovuto alla pandemia sono stati analizzati con strumenti di sorveglianza epidemica per stabilire se fosse possibile tracciare eventuali cluster epidemici nei territori bergamaschi e bresciani prima del riconoscimento dei primi casi di infezione alla fine di febbraio 2020. Nel complesso, questa tesi offre stime esaustive dei cambi nell’attività ospedaliera nel periodo pandemico, descrivendo accuratamente l’impatto che il COVID-19 ha avuto sul sistema sanitario nelle province di Bergamo e Brescia e, più ampiamente, sul Servizio Sanitario Regionale lombardo. I risultati forniscono, quindi, un’evidenza basata su dati di popolazione che aiuta a comprendere i disagi causati a pazienti e utenti dei servizi di salute. Le conclusioni di questo lavoro possono, quindi, servire da riferimento per orientare decisioni strategiche nella futura organizzazione dei servizi sanitari—non solo ospedalieri—nonché per sviluppare elementi di preparazione e risposta a COVID-19 e ad altri possibili eventi a carattere epidemico.
At the close of 2019, the COVID-19 pandemic caught the world off guard, promptly becoming the most severe health crisis of the past 100 years. The rapid surge in cases worldwide has impacted health systems, which, together with restriction measures such as lockdowns, has caused substantial disruptions in the provision of care for non-COVID-19 patients. To understand the extent of this indirect impact on the provision of hospital care for other conditions, this research investigated hospital and emergency department admissions during the pandemic period (up to June 2021) in the areas of Bergamo and Brescia, two densely populated provinces in northern Italy which were hardly hit during the first epidemic wave in February-April 2020. Longitudinal retrospective analyses were conducted using time-series data to model variations in hospitalizations and emergency department visits over the study period, using 2017–2019 as a reference. The indirect impact of COVID-19 on hospital care pathways was also evaluated by fitting time-series of their proxies (i.e., hospital access, hospitalization and mortality) of high-volume, non-deferrable clinical conditions. Furthermore, data on COVID-19-attributable excess of health events (hospital admissions and emergency department visits) were analysed through epidemic surveillance systems to learn whether there was evidence of SARS-CoV-2 transmission in Bergamo and Brescia provinces in the period preceding the recognized epidemic outbreak in late February 2020 using healthcare administrative database. This dissertation provides complete estimates of hospital activity during the pandemic period and accurately details the impact that COVID-19 has had on the health services in Bergamo and Brescia, as well as on the Lombardy Regional Health Service in general. The results provide population-based evidence that expands our understanding of the disruptions caused by the COVID-19 pandemic; findings could also be used to inform policy and management decisions to ensure that the most appropriate health service responses and preparedness are implemented.

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OLIVEIRA, Danielle Severien de Mendonça. « O custo das política de saúde pública : uma análise de custeio no serviço de radiologia do Hospital das Clínicas de Pernambuco ». Universidade Federal de Pernambuco, 2016. https://repositorio.ufpe.br/handle/123456789/18888.

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Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2017-05-25T13:54:15Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) DISSERTAÇÃO MPPP DANIELLE SEVERIEN CD.pdf: 2466466 bytes, checksum: e027b7607a7cd51e5fc6dde005431b74 (MD5)
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Uma organização hospitalar utiliza recursos de que dispõe para por em prática as políticas de saúde pública. Com o orçamento reduzido, o governo tem buscado formas de implementar suas políticas com o menor custo. O presente trabalho tem como objetivo principal analisar a viabilidade do sistema de custeio baseado em atividades (ABC) na avaliação de políticas de saúde pública no âmbito hospitalar, tendo como referência o serviço de radiologia do Hospital das Clínicas de Pernambuco. A metodologia utilizada para o trabalho foi o estudo de caso, onde os dados foram coletados a partir de entrevistas não estruturadas aos profissionais do setor e também através de análise documental. O trabalho prático seguiu um roteiro a partir das etapas descritas por Kaplan e Cooper (1998), que foram: 1) identificar as atividades; 2) atribuir os custos a cada atividade; 3) identificar os objetos de custos; 4) alocar os custos das atividades aos objetos. Como resultado, obteve-se a comparação entre os custos dos procedimentos radiológicos obtidos pelo método ABC e o custo pago pelo Sistema Único de Saúde (SUS). O estudo possibilitou identificar que a aplicação do método ABC neste serviço de saúde criou uma contribuição para que os gestores deste hospital possam estabelecer comparabilidade dos custos obtidos pelo método de custeio atual do Hospital das Clínicas de Pernambuco e os calculados nesta dissertação, permitindo-lhes, ainda, definir qual dos métodos é o mais adequado para atender as necessidades da organização. Ademais, os resultados comprovam a viabilidade do método como instrumento de monitoramento e avaliação de políticas de saúde pública no âmbito hospitalar.
A hospital organization uses its resources available to put into practice public health policies. Due to reduced budget, the government has sought ways to implement its policies with the lowest cost. This study aims mainly to analyze the feasibility of the activity-based costing system (ABC) in the evaluation of public health policies in hospitals, having as a reference the radiology department of the Hospital das Clínicas de Pernambuco. The methodology used for the study was the case study, which the data was collected from unstructured interviews with the department's professionals and also by documentary analysis. The practical work has followed a script according to the steps described by Kaplan and Cooper (1998), which were: 1) identify the activities; 2) assign costs to each activity; 3) identify the cost objects; 4) allocate the activities costs to the objects. As a result, we obtained a comparison between the costs of radiological procedures obtained by the ABC method and the cost paid by the Unified Health System (SUS). This study allowed us to identify that the application of the ABC method in this health service has created a contribution that allows the managers of this hospital to establish comparability of costs obtained by the actual cost method at the Hospital das Clínicas de Pernambuco and by the cost calculated in this dissertation, allowing them, also to define which method is best suited to meet the organization's needs. Furthermore, the results prove the feasibility of the method as a monitoring tool and evaluation of public health policies in hospitals.

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Büter, Kathrin. « Demenzsensible Akutkrankenhäuser ». Doctoral thesis, Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2017. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-229039.

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Vor dem Hintergrund der bekannten demografischen Entwicklung stehen Akutkrankenhäuser vor der Herausforderung, eine steigende Anzahl älterer Patienten mit Demenz versorgen zu müssen. Diese stellen im Krankenhaus eine hochvulnerable Patientengruppe dar. Die fremde Krankenhausumgebung, ungewohnte Tagesstrukturen und fehlende Bezugspersonen können die Desorientierung der Patienten begünstigen und herausfordernde Verhaltensweisen hervorrufen. Die oftmals erzwungene Passivität führt zu einer Verschlechterung der physisch-funktionalen Fähigkeiten und des kognitiven Status. Folglich wird für viele Patienten mit Demenz ein Übergang in eine Pflegeeinrichtung im Anschluss an den Krankenhausaufenthalt unausweichlich. Forschungserkenntnisse der letzten dreißig Jahre aus der stationären Altenpflege weisen auf einen positiven Einfluss räumlicher Eigenschaften auf Menschen mit Demenz hin. Darauf aufbauend werden nunmehr auch in Akutkrankenhäusern vermehrt demenzsensible architektonische Maßnahmen umgesetzt. Dennoch weisen Krankenhäuser spezifische medizinische, pflegerische und organisatorische Anforderungen auf, die einer einfachen, direkten Übertragung der vorhandenen Erkenntnisse entgegenstehen. Eine Anpassung und Erprobung demenzfreundlicher Maßnahmen ist im Krankenhaus erforderlich. In dieser Dissertation wurden zunächst auf Basis des Erkenntnisstandes zu demenzfreundlicher Architektur und einer Analyse der räumlichen Anforderungen an demenzsensible Krankenhäuser Handlungsfelder für die demenzfreundliche Gestaltung von Krankenhausstationen abgeleitet. Verschiedene Dimensionen einer barrierefreien, sicheren, orientierungsgebenden und anregenden Umwelt wurden dabei als wesentlich für die Unterstützung von Patienten mit Demenz identifiziert. Des Weiteren wurde mittels einer eigenen empirischen Untersuchung die Wirksamkeit mehrerer baulicher und gestalterischer Maßnahmen auf einer internistischen Krankenhausstation evaluiert. Die Interventionen zielten dabei primär auf die Aktivierung und Mobilisierung von Patienten mit Demenz ab. Die Ergebnisse der Untersuchung zeigen, dass die Einrichtung eines zentral gelegenen Aufenthaltsbereichs auf einem Stationsflur und die Ausstattung mit vielfältigen Beschäftigungsangeboten zu einer signifikanten Steigerung der Aktivitäten und Interaktionen von Patienten mit Demenz führte. Die räumliche und visuelle Nähe zum Dienstzimmer der Pflegekräfte und die Ausgestaltung des Aufenthaltsbereichs als räumlichen Ankerpunkt stellten zentrale architektonische Parameter dar. Des Weiteren wird in der Untersuchung deutlich, dass die Architektur einen Beitrag zur Steigerung der Arbeitszufriedenheit von Pflegekräften und folglich zu einer ganzheitlichen Verbesserung der Versorgungssituation von Patienten mit Demenz leisten kann. Die gewonnenen Erkenntnisse wurden schließlich in Planungsempfehlungen für die Gestaltung demenzsensibler und aktivierender Krankenhausstationen übertragen.

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Cunningham, Natalie Lorinda. « The profile and outcomes of stroke patients discharged from a hospital In the Eastern Cape ». Thesis, University of Western Cape, 2012. http://hdl.handle.net/11394/3368.

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Magister Scientiae (Physiotherapy) - MSc(Physio)
Stroke is the third leading cause of death and disability worldwide. The Uitenhage Provincial Hospital admits many stroke patients. To date, no in-depth study has been conducted on stroke patients admitted to the Hospital. This study identified the profile of stroke patients admitted to the Uitenhage Provincial Hospital and explored the challenges that these patients experienced post stroke. A concurrent mixed model design was used to collect the data. Firstly retrospective data was obtained by means of a quantitative data gathering instrument designed by the researcher. The information obtained, included data relating to demographic characteristics, reported risk factors relating to stroke, stroke onset-admission interval and length of hospital stay, as well as information relating to the process of physiotherapy. Secondly quantitative prospective information was collected by means of the Barthel Index, the Modified Rankin Scale and the Facilitators And Barriers Survey. The sample for the quantitative phase was drawn from medical records of 168 stroke patients admitted to the Uitenhage Provincial Hospital from the 1 of January 2008 up to and including the 31 of December 2009. For the second prospective quantitative part of the study, participants were selected conveniently from the admitted patients. In the qualitative phase, nine participants taken of the sampled participants were selected. The Microsoft Excel 2007 Package and the SPSS 18 for social sciences were used to analyse the quantitative data. Means, standard deviations, frequencies and percentages were calculated for descriptive purposes and the Chi-square test was used to test for associations between variables. Qualitative analysis began with the transcription of voice recordings and the translation of relevant Afrikaans transcription into English. Emerging categories were identified within the pre-determined themes. Permission and ethical clearance was obtained from the Higher Degrees Committee and the Senate Research and Grants and Study Leave Committee of the University of the Western Cape and permission to conduct this study was also obtained from the Medical Superintendent of the Uitenhage Provincial Hospital. Altogether 461 patients had been admitted with stroke during the relevant period, but only 168 could be included in the retrospective quantitative study. The mean age of the participants was 61,54 years; 59% were females and 41% males. The majority of the participants (86,9%) were admitted on the same day of stroke onset, and the mean length of hospital stay was 7,38 days. Hypertension was the most common reported risk factor, at 79%. Only 165 of the participants received physiotherapy while hospitalised, with the mean total physiotherapy sessions being 2,56 sessions. In 90% of the cases, physiotherapy sessions were discontinued due to the patient being discharged from the Hospital. The mean Barthel Index score was 81,46 and the family care domain of the Modified Rankin Scale was the most affected. Participants experienced participation restrictions and activity limitations due to stairs, gravel surfaces and kerb cuts. During the qualitative interviews participants reported activity limitations related to walking and activities of daily living. The participants also experienced participation restrictions, which included dependency on others, decreased social support and an array of emotions experienced post stroke. The current study’s findings suggest that the discharge of patients from the hospital post stroke should follow a mulitidisciplinary approach. Rehabilitation professionals should play an active role in the discharge process in providing patient and caregiver education.

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Ribeiro, Natalia Camarão Telles. « Fatores associados a quedas em idosos portadores da doença de chagas assistidos em ambulatorio de hospital universitario ». [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310906.

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Orientador: Maria Elena Guariento
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: No Brasil, estima-se que 30% dos idosos caem pelo menos uma vez ao ano. A preocupação com este tema incide em questões de ordem médico-assistenciais, particularmente na crescente demanda por estes serviços. Acredita-se que os fatores associados a quedas possam atuar em menor ou maior intensidade entre os idosos, conforme suas condições de vida. Um contingente cada vez maior de portadores de doença de Chagas está envelhecendo e, assim, expondo-se mais ao risco de quedas, além de enfrentar as complicações decorrentes dessa enfermidade infecciosa crônica. Sendo assim, delineou-se este estudo com o propósito de se analisar o comportamento dos fatores de risco para quedas em idosos com doença de Chagas, considerando-se: características sócio-demográficas, clínicas, de auto-avaliação de saúde e de prática de atividade física. Os instrumentos utilizados foram: Instrumento de Coleta de Informações Sócio-Demográficas e Clínicas, retiradas do Banco de Dados do Projeto Temático "Doença de Chagas, Envelhecimento e Qualidade de Vida" e Questionário para Identificação de Agentes Predisponentes a Quedas em Idosos. As variáveis foram analisadas pelos testes Qui-quadrado ou Exato de Fischer, de Mann-Whitney, Análises de Cluster e de Regressão Logística Univariada. Foram entrevistados 43 idosos chagásicos de ambos os gêneros, sendo 21 (48,84%) mulheres, 35 (81,4%) entre os 60 e 69 anos. Verificou-se que 14 (32,54%) relataram queda, em consonância com achados de estudos com idosos não infectados pelo T. cruzi. A Análise de Cluster permitiu formar dois agrupamentos: um deles composto predominantemente por homens, cardiopatas, com maior referência à prática de atividade física e o outro composto predominantemente por mulheres, com idosos classificados nas formas clínicas mista, digestiva e indeterminada e menor referência à prática de atividade física. Dentre as variáveis estudadas, nenhuma foi preditiva para ocorrência de quedas.
Abstract: It is estimated that 30% of the aged in Brazil fall at least once a year. The importance of this fact has to do with medical and social assistance care and with the increasing demand for the related services. It is believed that the factors which cause these falls of the aged are associated with their living conditions. A growing group of people with the Chagas disease are getting older and, therefore, have more propensity to fall, besides having to deal with the complications associated with this chronic infectious disease. In view of these facts, we formulated this study the risk factors of the aged with the Chagas disease, while taking into account the social-demographic, clinical, self health evaluation and physical activity characteristics of the study group. To perform the study we used the following instruments: "The Instrument for Collection of Social-Demographic and Clinical Information", of which were taken the Data Bank of the Thematic Project: "Chagas Disease, Aging and Quality of Life" and "The Questionnaire for Identification of Causes of Falls among the Aged". We analysed the numerical results with the following: Chi-square Test , Fischer's Exact Test, Mann-Whitney Test, Univariate Logistic Regression Analysis and Cluster Analysis. We interviewed 43 aged persons of both sexes with the Disease of Chagas: 21 (48.84%) female and 35 (81.4%) between 60 and 69 years of age.We found that 14 (32.54%) reported falls, in agreement with the results of studies of the aged not infected with T. Cruzi. Cluster analysis permitted the formation of two groups of the results: one, predominantly male, with heart disease, with more intense physical activity and the other, predominantly female, classified clinically as mixed, digestive and indeterminate, with less intense physical activity. None of the studied variables was predictive of falls.
Mestrado
Mestre em Gerontologia

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Järvinen, J. (Janne). « Rationale for adopting activity-based costing in hospitals:three longitudinal case studies ». Doctoral thesis, University of Oulu, 2005. http://urn.fi/urn:isbn:9514279484.

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Abstract In the 1990's, a large number of Finnish hospitals began implementing new cost accounting systems, which were aimed at pricing the hospital outputs at full cost. Often the method of choice was activity-based costing, which was in the process of being transferred from the manufacturing industry to health care service production. The aim of this study is to analyse the motivations and rationale of this phenomenon in the light of three longitudinal case studies. The first case study is archival, using documents produced between 1996 and 2002. In the second case study, the data consists mainly of research diaries and personal observation and covers a hospital district activity-based costing and pricing project of 2000–2001. The third case study covers budgeting and costing development in a private, non-profit hospital by analysing documents and field notes. Institutional theory is used to interpret the findings in the three case studies. The theoretical framework used in analysing the data draws on Roberts and Greenwood's (1997) ideas, according to which an organisation's rational and efficiency-seeking actions are constrained by both economic (bounded rationality) and institutional factors. The results indicate that different constraints imposed on efficiency-seeking behaviour such as activity-based costing implementation may lead to different solutions concerning implementation. It is noteworthy that while all three case organisations represent the health care sector, their approaches to activity-based costing have been quite dissimilar. While institutional theory leads us to believe that managerial accounting systems may be converging due to the institutional pressures, evidence from the case studies supports the notion that this convergence seems limited to the adoption of the systems – function of the systems seems to remain characteristically different
Tiivistelmä Useat suomalaiset sairaalat aloittivat 1990-luvulla laajamittaisia kustannuslaskentaprojekteja, joissa tähdättiin täyskatteiseen hinnoitteluun. Usein valittuna menetelmänä oli toimintolaskenta, jota siirrettiin teollisesta toimintaympäristöstä terveydenhuollon palvelutuotantoon. Tutkimuksen tavoitteena on tarkastella tämän ilmiön syitä ja motiiveja kolmen tapaustutkimuksen valossa, joista kaksi on sairaanhoitopiirejä ja kolmas on voittoa tavoittelemattoman yhteisön omistama yksityinen sairaala. Ensimmäisessä tapaustutkimuksessa aineisto on dokumentteihin perustuvaa arkistomateriaalia vuosilta 1996–2002. Lisäksi kustannuslaskentamallien rakennetta on tarkasteltu käymällä läpi laskelmissa tehtyjä rakenteellisia ja teknisiä ratkaisuja sekä laskentasääntöjä. Toisessa tapaustutkimuksessa aineisto koostuu pääasiassa tutkijan päiväkirjoista ja havainnoista, ja sisältää sairaanhoitopiirin laajuisen kustannuslaskenta- ja hinnoitteluprojektin kuvauksen vuosilta 2000–2001. Kolmannessa tapaustutkimuksessa käydään läpi yksityisen sairaalan budjetoinnin ja kustannuslaskennan kehitystä dokumentteihin ja tutkijan muistiinpanoihin nojautuen. Teoreettisena viitekehyksenä aineiston tulkinnassa käytetään Robertsin ja Greenwoodin (1997) rajoitetun tehokkuuden mallia, jonka mukaan organisaation tehostamispyrkimyksiä rajoittavat sekä taloudelliseen rationaalisuuteen liittyvät tekijät (rajoitettu rationaalisuus) että institutionaaliset tekijät. Tutkimuksen tulokset osoittavat, että erityyppiset rajoittavat tekijät vaikuttavat organisaatioiden tehokkuuspyrkimyksiin (joihin toimintolaskentaprojektit on luettava) siten, että lopputuloksena on erilaisia sovelluksia toimintolaskennan käyttöönotosta. On huomionarvoista, että vaikka kaikki tutkimuksen kohteena olleet tapaukset ovat erikoissairaanhoidon organisaatiota, niiden tavat ottaa toimintolaskenta käyttöön ovat olleet toisistaan hyvin poikkeavia. Vaikka institutionaaliseen teoriaan perustuvasta tutkimuksesta voikin tehdä sellaisen johtopäätöksen, että ulkoiset paineet muovaavat organisaatioita samanlaisiksi, näiden tapaustutkimusten perusteella on mahdollista väittää, että samanlaisuuden paineet liittyvät laskentajärjestelmien käyttöönottoon järjestelmien toiminnan jäädessä varsin erityyppisiksi

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Takeda, Osvaldo Hakio. « Contribuição da atividade física no tratamento do portador de transtorno mental grave e prolongado em Hospital-Dia ». Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/7/7134/tde-30102006-095714/.

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Tendo como meta a reabilitação psicossocial, o Centro de Reabilitação e Hospital-Dia do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (CRHD do IPqHCFMUSP) propicia aos pacientes uma gama variada de atividades terapêuticas grupais, com a finalidade de resgatar habilidades que o adoecer psíquico comprometeu, e de estimular potenciais não prejudicados assim como sua autonomia. Oferece a possibilidade de participar de psicoterapia, terapia ocupacional, atividade externa, convivência, desenho e pintura, literatura, cidadania, conscientização, psicodrama, cozinha experimental, reorientação ocupacional, vídeo, lazer, dança, massoterapia e atividade física. Esse leque de atividades, porém, torna difícil, para o pesquisador, avaliar a influência de cada uma isoladamente. Neste estudo, optamos por estudar o comportamento do paciente no Grupo de Atividade Física do CRHD citado, tendo foco a atividade terapêutica desenvolvida nesse grupo. Seus objetivos foram. 1)Validar um instrumento para observação da evolução do comportamento do paciente no Grupo de Atividade Física programada: 2) Observar a evolução do paciente nos aspectos dos domínios motor, cognitivo e afetivo-social no Grupo de Atividade Física do CRHD, segundo o instrumento elaborado; 3) Levantar hipóteses sobre a contribuição da atividade física programada no comportamento do portador de transtorno mental e na reabilitação psicossocial. Esta pesquisa foi desenvolvida em duas etapas: na primeira, utilizamos a pesquisa metodológica para a construção de um instrumento que nos permitisse, na segunda etapa, observar a evolução dos pacientes no Grupo de Atividade Física, por meio da pesquisa exploratória-descritiva. O local da pesquisa foi o CRHD citado. A população, constituída por dez pacientes admitidos no CRHD, que participaram do Grupo de Atividade Física. Eram adultos, de ambos os sexos, de diferentes faixas etárias, níveis sócio-econômico-cultural e condições físico-motoras. Foram respeitados os aspectos éticos preconizados pelo Conselho Nacional de Saúde e obteve-se a aprovação do Comitê de Ética da Escola de Enfermagem da USP e da Comissão de Ética da Diretoria Clínica do Hospital das Clínicas da Faculdade de Medicina da USP e assinado Termo de Consentimento Livre e Esclarecido. A maioria (9) dos participantes recebeu o diagnóstico de esquizofrenia e a totalidade (10) fazia tratamento com drogas psicotrópicas. O presente estudo não permite generalizações, portanto, as conclusões a seguir aplicam-se à população estudada: o instrumento construído para observação do comportamento do paciente no Grupo de Atividade Física foi validado, pré-testado e considerado adequado para a finalidade do estudo; as atividades físicas programadas estimularam o desenvolvimento dos participantes nos domínios motor, afetivo-social e cognitivo, tanto pela análise do pesquisador como na visão dos pacientes; e, foi possível identificar várias hipóteses sobre os resultados para futuros estudos.
Focusing on the psychosocial rehabilitation, the Rehabilitation Center and Day Hospital (RCDH) of the Psychiatry Institute at Hospital das Clínicas of the School of Medicine at University of Sao Paulo offers its patients a wide range of therapeutic activities, aimed at retrieving abilities compromised by psychiatric condition, as well as stimulating unharmed potential abilities and patients autonomy. Therapeutic activities include psychotherapy, occupational therapy, field trips, exchange experience group, citizenship, conscientization, sketching and painting, literature, psychodrama, cooking, vocational orientation, video, leisure, dance, massage therapy, and physical activity. This array of activities makes it difficult for a researcher to evaluate the influence of each activity. In the present research, we studied the behavior of patients of the Physical Activity Group at the RCDH, focusing on the therapeutic activity carried out by that group. The aims of the study were: 1) To validate a tool to observe the evolution of patient behavior at the Physical Activity Group; 2) Observe the evolution of patient concerning motor, cognitive and affective domains, according to the previously mentioned tool; 3) Establish hypotheses regarding the contribution of programmed physical activity to behavior and psychosocial rehabilitation of outpatients with mental health problems. The study was carried out in two phases: in the first phase, methodological research was used to develop a tool to be used in the second phase, which consisted of the observation of the evolution of patients in the Physical Activity Group, through exploratory-descriptive research. The setting was the RCDH mentioned above. The participants were ten patients at the Rehabilitation Center participating in the Physical Activity Group adults, both male and female, from different age groups and social backgrounds and presenting different physical-motor skills. Ethical aspects recommended by National Council of Health were observed and approval was obtained both from the Ethics Committees of School of Nursing USP and Clinical Board of Hospital das Clínicas School of Medicine USP. Written informed consent was obtained from participants. Most participants (n=9) were diagnosed with schizophrenia and all participants (n= 10) were using psychotropic drugs. The present study does not allow for generalizations. Therefore, following conclusions apply solely to the population studied: the tool developed for observation of behavior of the patient in the Physical Activity Group was validated, pre-tested and considered adequate for the purpose of the study; the programmed physical activities stimulated development of participants in motor, affective-social and cognitive domains, both from the point-of-view of the researcher as well as of patients; and, finally, it was possible to establish various hypotheses about the results for future investigation.

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Tavares, Luciani Bueno. « A teoria da atividade como instrumento de análise da escola : o caso da EMAE ». Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/81/81131/tde-26022013-102656/.

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A presente dissertação possui como problemática de pesquisa o trabalho docente na Escola Móvel/Aluno Específico, localizada na cidade de São Paulo. A atuação de profissionais da área de educação em ambientes hospitalares ocorre no Brasil desde a década de cinquenta. Todavia, trata-se de um campo de investigação científica ainda pouco explorado, em especial quando lançamos o olhar sobre o Ensino de Ciências neste contexto. Como base teórica, foi utilizada a Teoria da Atividade como uma ferramenta analítica da atividade docente. A escolha e aplicação deste instrumento teórico-metodológico justificam-se pelo enfoque no desenvolvimento humano nos âmbitos sociais, culturais e históricos, em que a ação individual adquire sentido através das relações que se estabelecem na atividade coletiva. Foram realizadas entrevistas semiestruturadas com professores de ciências que atuaram em diferentes períodos na escola hospitalar e também com coordenadores. A análise dos dados permitiu identificar dimensões de contradições que expressam algumas das características do ser docente na escola hospitalar. Tais evidências explicitam a necessidade de repensarmos os cursos universitários de Licenciaturas, de modo, que incluam no seu processo formativo meios de preparar o professor para que consiga se adaptar a diferentes tipos de ambientes pedagógicos com diferentes tempos, espaços e finalidades.
This thesis has as research problem the teacher\'s work in a hospital school in São Paulo city. The professionals of education have been working in hospitals in Brazil since the fifties. However, it is a field of research that is underexplored, especially when we launched the look on the Teaching of Science in this context. As theoretical basis, we used the Activity Theory as an analytical tool of teacher\'s activity. The selection and application of this theoretical-methodological tool is justified by the focus on human development in social, cultural and historical areas, in which individual action acquires meaning through relationships established in the collective activity. To support the data, we used transcripts of interviews with science teachers who worked in different time periods in the hospital school. Data analysis identified the dimensions of contradictions that express some of the characteristics of being a teacher in the hospital school. Such findings clearly demonstrate the need for rethinking undergraduate university courses, in order to include in educational process ways to prepare the teacher to suit different types of learning environments, with different times, spaces and purposes.

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Miyazaki, Eduardo Santos. « Burnout, qualidade de vida e atividade física em profissionais de unidade de terapia intensiva de hospital escola ». Faculdade de Medicina de São José do Rio Preto, 2015. http://hdl.handle.net/tede/426.

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To work in health care settings, especially in Intensive Care Unities (ICUs), has been associated with high levels of stress and burnout. Objective: to assess burnout, physical activity practice, and quality of life in professionals working in ICUs in a high complexity hospital. Method: descriptive cross-sectional study performed at the following ICUs: SUS (Unified Health System), Health Insurance, Emergency and Cardiology, with nursing, medical and physical therapy professionals. Participants (n=141) filled an identification questionnaire, the International Physical Activity Questionnaire (IPAC), the Maslach Burnout Inventory (MBI) and the WHOQOL-Bref, World Health Organization instrument (brief) to asses quality of life. Results : Participants mean age was 34,55 ± 8,74, 70% were female and 47,1% were single. Professionals reported working from 20 to 120 hours a week ( mean 48,97 ± 17,4), 53 (38,1%) had more than one job and 46 (35,9%) worked on call. IPAC results indicated that 30,7% (N=43) reported low levels of physical activity, 35% (N=49) reported moderate levels, and 34,3 (N=48) reported high levels. None of the pawrticipants presented burnout although burnout symptoms were presente. Significant diferences were observed between groups: a) despersonalization was lower for the Ucor group when compared to the SUS group (p=0,021); b) the Emergency group reported higher levels of physical activity when compared to the SUS group (p=0,03); c) despersonalization was lower for the Emergency group when compared to the SUS group (p=0,039). Ucor professinals presented higher quality of life scores when compared with professional from other ICUs. Conclusions: participants reported higher levels of physical activity practice when compared to the literature. None of the participants presented burnout, although they had burnout symptoms. There was a difference between professional from diferente concerning despersonalization and quality of life.
Trabalhar na saúde, inclusive em Unidades de Terapia Intensiva (UTIs), tem sido associado a altos níveis de estresse e burnout. Objetivo: Avaliar burnout, prática de atividade física e qualidade de vida entre profissionais que trabalham em UTIS de um hospital de alta complexidade. Método: estudo descritivo, transversal, realizado nas UTIs do SUS, do Convênio, da Emergência e da Cardiologia (UCor) com profissionais das áreas de enfermagem, medicina e fisioterapia. Os participantes responderam individualmente a um Questionário de identificação, ao Questionário Internacional de Atividade Física (IPAQ), ao Maslach Burnout Inventory (MBI) e ao WHOQOL-Bref , instrumento da Organização Mundial de Saúde para avaliar qualidade de vida. Resultados: Dos 251 questionários entregues, 142 foram devolvidos e seus dados incluídos estudo. A média de idade foi 34,55 ± 8,74 anos, 70% dos participantes eram do sexo feminino e 47,1% eram solteiros. Os profissionais relataram trabalhar de 30 a 120 horas por semana (média: 48,97 ± 17,4), 53 (38,1%) tinham mais que um emprego e 46 (35,9%) eram plantonistas. Os resultados do IPAQ indicaram que 30,7% (N=43) realizavam nível baixo de atividade física, 35% (N=49) nível moderado e 34,3% (N=48) nível alto. Nenhum dos participantes do estudo apresentou burnout, apesar de sintomas estarem presentes. Diferenças significantes foram encontradas entre os grupos: a) o índice de despersonalização no grupo Ucor foi menor que o encontrado no grupo SUS (p=0,021); b) o grupo da Emergência relatou uma prática de atividade física mais intensa quando comparada ao grupo do SUS (p=0,03); c) o índice de despersonalização do grupo Emergência foi menor que o do grupo SUS (p=0,039). Profissionais da Ucor apresentaram melhores índices de qualidade de vida em relação aos funcionários das outras unidades. Conclusões: a prática de atividade física relatada pelos participantes foi superior à encontrada na literatura. Não foram identificados profissionais com burnout, embora sintomas estivessem presentes. Houve diferença entre profissionais de diferentes UTIs em relação a despersonalização e qualidade de vida.

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Montoro, Silene Barbosa. « Influencia da orientação personalizada para atividade fisica na melhora da condição clinica e fisica de crianças e adolescentes obesos no Hospital de Clinicas da Unicamp ». [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308168.

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Orientador: Angelica Maria Bicudo Zeferino
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Com o intuito de prestar assistência às crianças e aos adolescentes obesos com maior risco de doenças, oriundos da área de cobertura do Hospital de Clínicas da Unicamp, foi criado o Ambulatório de Obesidade Infantil da Criança e do Adolescente. Este estudo teve como objetivo avaliar a eficácia da orientação para atividade física feita por profissional Educador Físico no serviço de atendimento de crianças e adolescentes obesos do Hospital de Clínicas da Unicamp. Trata-se de um estudo longitudinal das crianças e adolescentes de 07 a 19 anos que fizeram pelo menos duas avaliações de performance com espaço mínimo de 12 meses entre a primeira e a segunda avaliação. Dos 150 pacientes atendidos, 77 pacientes aderiram à atividade física após a primeira consulta (51%); dentre esses, 33 permaneceram em atividade física pelo menos por 12 meses (43%). Houve melhora significativa da distância percorrida no teste vai-e-vem 20 metros entre os meninos. Houve aumento do IMC nos dois gêneros. Não houve impacto significativo nas outras variáveis estudadas (PA, FC e indicadores bioquímicos).
Abstract: Intending to give assistance to children and teenagers that are obese in risk of disease, coming from of the area of the hospital of the Unicamp, it was created the obesity out-patient clinic of the children and teenagers. The goal of this research was test the efficacy of guidance for physical activity done by Physical Educator professional in customer service for obese children and adolescents at the clinic hospital of the Unicamp. This is a longitudinal study regarding children and teenagers between seven and nineteen years old, who took at least two examinations of performance, with a minimum period of twelve months between the first and the second examination. The results of the 150 patients attempted is about 77 started practicing physician activities after the first appointment with a the physical educator (51%), among them 33 kept those activities for at least one year (43%).There have been some increase in the good results about the distance covered in the 20 meters come and go test among the boys There have been some increase either on the IMC in both two genders There haven't been meaningful impacts on the other data searched (PA, FC and some biochemistry indicator).
Mestrado
Saude da Criança e do Adolescente
Mestre em Saude da Criança e do Adolescente

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Skaal, Linda. « The Predictive validity and effects of using transtheoretical model to increase physical activity of health workers at Dr. George Mukhari Hospital, South Africa ». Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/535.

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Thesis (MPH) -- University of Limpopo (Medunsa Campus), 2010.
Background: Evidence exists that supports the physiological and psychological benefits associated with regular physical activity. The Transtheoretical model (TTM) of the stages and processes of change has been used worldwide to understand how people change problem behaviour, such as Physical Inactivity, and correctly categorize people according to their readiness to change from being physically inactive to being active. This model (TTM) helps Health Promoters to implement awareness campaigns according to individual’s stage of exercise change. The overall aim of this study is to determine the predictive validity and effects of using Transtheoretical model to increase physical activity of health workers at Dr. George Mukhari Hospital in South Africa. Methods: Research design: A quasi-experimental design was used. A total of 200 subjects (both medical and non-medical staff) were randomly selected from the hospital staff. The following parameters were measured at baseline: TTM Stage (Questionnaire), fitness levels (step test), BMI (Electronic scale), attitude and knowledge (Questionnaire). Phase 11: impact evaluation; exposure levels; Phase 111: Knowledge; Attitude; TTM post intervention. The results were analyzed using SPSS 17.0 version and excel programs. Chi square test was used to analyse and calculate the p-value scores. Paired Sample t-test was used to compare means and binomial and multiple logistic regressions were used to calculate predictive validity of TTM. Results: Two hundred staff members with mean age of 43.12 and standard deviation of 10.75 were investigated. Baseline results showed that the majority of the participants were at Pre-Action stage (76%) and only 24% were at Action stage; with only 27% who had Normal weight and 73% Overweight and Obese. NCDs are common in many participants, with obese ones being more affected than normal staff. Nonmedical staff had poor knowledge compared to medical staff (p<.05). Majority of staff generally had positive attitude towards PA. There was a significant difference (p<.050) between males and females in each TTM stage, with more adult males being in Action/maintenance stages compared to adult females who were mainly at pre-action stages. Majority of older patients were obese (p<.05), had a good perception about their weight and at pre-action stages. Post intervention, Mean scores of TTM (3.699) and Knowledge (3.651) were significantly (p<.05) higher at post test. Both medical and nonmedical staff mainly used Environmental re-evaluation and Self re-evaluation as processes of behaviour change. Precontemplators only used 2 processes to change behaviour. Post intervention: high levels of exposure; Processes of Change, knowledge and attitude resulted in increased TTM stages of staff (p=.000). TTM, knowledge, attitude, process of change and level of exposure were used as predictors of behaviour change and significantly predicted success post test. Overall accuracies of TTM at pre-test could be classified correctly of TTM at post test by average 66.9 % for overall participants; 78.3% for medical staff and only 65% for non-medical staff. Thus the predictor (TTM1) had significant contribution to the outcome (TTM2). Conclusion: Obesity is a common problem and is predisposed by physical inactivity because the majority of staff is old, and this puts them at risk of inactivity-related chronic diseases of lifestyle. Level of physical activity was significantly associated with BMI and may be one of the most important risk factors associated with obesity among hospital staff. The use of TTM to identify the stage of PA of healthcare workers (HCW) has enabled the researcher to design intervention programs specific to the stage of exercise behaviour of staff. Thus the predictors (TTM1), exposure levels, knowledge, attitude and Processes of change have significant contribution to the outcome (TTM2).

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Oliveira, Alexandra Martini de. « Ensaio clínico randomizado e controlado para avaliar a versão brasileira ambulatorial do método TAP (Tailored Activity Program - Programa Personalizado de Atividades) no tratamento de sintomas neuropsiquiátricos em indivíduos com demência ». Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5142/tde-05122018-132604/.

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INTRODUÇÃO: Embora os quadros demenciais sejam caracterizados, principalmente, por comprometimentos cognitivos e funcionais, muitos pacientes apresentam alterações comportamentais ou sintomas neuropsiquiátricos (SNPs) em alguma fase de sua história clínica. De acordo com a literatura atual, os SNPs são muito frequentes, podendo ocorrer em até 90% dos casos de demência. Dentre os SNPs mais comuns, estão incluídos: agressividade, apatia, agitação, perambulação, desinibição, ansiedade, humor deprimido e sintomas psicóticos (alucinações e delírios). Diretrizes internacionais têm sugerido que os tratamentos não-farmacológicos devem ser a primeira opção na abordagem dos SNPs. Recentemente, os estudos têm mostrado que as intervenções não-farmacológicas são tão eficazes quanto os tratamentos farmacológicos, no entanto, sem ocasionar os efeitos colaterais e riscos das medicações. Uma abordagem não-farmacológica promissora é o uso de atividades. Um método de Terapia Ocupacional, denominado Tailored Activity Program (TAP - Programa Personalizado de Atividades - versão domiciliar) foi desenvolvido com o objetivo de reduzir e prevenir SNPs em idosos com demência moderada a grave e, de acordo com os estudos, tem se mostrado eficaz. No Brasil, existem poucos estudos sobre abordagens nãofarmacológicas no tratamento de SNPs em indivíduos com demência. OBJETIVOS: Realizar a tradução e adaptação transcultural do método TAP para a língua portuguesa, bem como sua adequação para o uso ambulatorial. Avaliar a eficácia do método TAP (versão ambulatorial brasileira) no tratamento de SNPs de indivíduos com demência moderada a grave e na redução da sobrecarga dos seus cuidadores. MÉTODO: Trata-se de um ensaio clínico aleatorizado, controlado, duplamente encoberto, para o tratamento de SNPs em idosos com demência moderada a grave, através da versão traduzida e adaptada do método TAP para uso ambulatorial. O grupo experimental recebeu oito sessões baseadas no método TAP, em regime ambulatorial, e o grupo controle recebeu oito sessões baseadas em um programa psicoeducativo com orientações sobre demência. As medidas de desfecho consistiram na avaliação de SNPs dos indivíduos com demência, por meio do The Neuropsychiatric Inventory-Clinician rating scale (NPI-C), e da avaliação da sobrecarga dos seus cuidadores, por meio da Escala Zarit. Todos os participantes foram avaliados nos momentos pré (T0) e pós-intervenção (T1). RESULTADOS: Foram incluídos 54 indivíduos com demência, que foram alocados para as condições experimental (n= 28) e controle (n= 26). Observou-se melhora estatisticamente significante no grupo experimental nos seguintes SNPs: delírios (p=0,05), agitação (p=0,001), agressividade (p=0,007), depressão (p=0,008), ansiedade (p=0,006), euforia (p=0,007), apatia (p=0,02), desinibição (p=0,03), irritabilidade (p=0,03), distúrbio motor (p=0,007) e vocalizações aberrantes (p=0,03). Por sua vez, não foi observada melhora nos seguintes SNPs: alucinações (p=0,06), distúrbios do sono (p=0,06) e distúrbios do apetite (p=0,5). O método TAP para uso ambulatorial também se mostrou clinicamente eficaz na redução da sobrecarga nos cuidadores do grupo experimental (p=0,01). CONCLUSÃO: Este ensaio clínico é o primeiro estudo controlado sobre a eficácia de uma intervenção de Terapia Ocupacional baseada na versão ambulatorial do método TAP para aliviar os SNPs em pacientes com demência moderada a grave. Os resultados mostraram que o uso de atividades prescritas de maneira personalizada, aliada ao treinamento do cuidador, pode ser uma abordagem clinicamente eficaz na redução de SNPs e da sobrecarga de cuidadores de indivíduos com demência
INTRODUCTION: Although dementia is characterized mainly by cognitive and functional deficits, many patients present behavioral changes or neuropsychiatric symptoms (NPS) at some stage of their clinical evolution. According to the current literature, NPS are very frequent and may occur in up to 90% of dementia cases. The most common NPS are aggression, apathy, agitation, wandering, disinhibition, anxiety, depressed mood and psychotic symptoms (hallucinations and delusions). International guidelines have suggested that non-pharmacological treatments should be the first option in clinical approaching to NPS. Recently, studies have shown that nonpharmacological interventions are as effective as pharmacological treatments, however without the side effects and risks of medications. A promising nonpharmacological approach is the use of activities. An Occupational Therapy method, called Tailored Activity Program (TAP), was developed with the objective of reducing and preventing NPS in the elderly with moderate to severe dementia and, according to published studies, has shown to be effective. In Brazil, there are few studies on non-pharmacological approaches in the treatment of NPSs in individuals with dementia. OBJECTIVES: To perform the translation and transcultural adaptation of the TAP method to Brazilian Portuguese, as well as its adequacy for outpatient use. To evaluate the efficacy of the TAP (Brazilian outpatient version) method in the treatment of NPS in individuals with moderate to severe dementia and in the burden reduction of their caregivers. METHOD: This is a randomized, double-blind, controlled clinical trial for the treatment of NPS in elderly with moderate to severe dementia., using the transcultural translation and adaptation of the outpatient TAP method. The experimental group received eight sessions based on the TAP method, on an outpatient basis, and the control group received eight sessions based on a psychoeducational program with orientations about dementia. Outcome measures consisted of assessing the NPS of individuals with dementia, through the Neuropsychiatric Inventory-Clinician rating scale (NPI-C), and assessing the burden on their caregivers, using the Zarit Scale. All the participants were evaluated at pre (T0) and post-intervention (T1). RESULTS: We included 54 individuals with dementia, who were allocated to the experimental (n=28) and control (n=26) groups. There was improvement of the following NPS in the experimental group: delusions (p=0.05), agitation (p=0.001), aggressiveness (p=0.007), depression (p=0.008), anxiety (p=0.006), euphoria (p=0.007), apathy (p=0.02), disinhibition (p=0.03), irritability (p=0.03), motor disturbance (p=0.007) and aberrant vocalization (p=0.03). No improvement was observed in the following NPS: hallucinations (p=0.06), sleep disturbances (p=0.06) and appetite disorders (p=0.5). The TAP method for outpatient use was also clinically effective in reducing burden in the caregivers of the experimental group (p=0.01). CONCLUSION: This clinical trial is the first controlled study of the efficacy of an Occupational Therapy intervention based on the outpatient version of the TAP method to relieve NPS in patients with moderate to severe dementia. The results showed that the use of personalized prescribed activities, coupled with the caregiver training, may be a clinically effective approach to reduce NPS and caregiver burden of individuals with dementia

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Alfridsson, Ulrika. « Patientens upplevelse av nattens timmar inom vuxenpsykiatrisk heldygnsvård ». Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-21789.

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Sömnen är viktig för att kroppen och hjärnan ska kunna återhämta sig. Sömnen är avgörande för välbefinnandet och vår hälsa på många sätt. Det går att påverka sömnen till det bättre och det har verkan på hur kropp och psyke mår och orkar dagen därpå. Som patient inneliggandes på en vårdavdelning är människan utlämnad till personal och vårdmiljö, det kan därför bli svårare att själv påverka sin sömn. Syftet med denna intervjustudie var att undersöka hur patienter inskrivna inom den vuxenpsykiatriska heldygnsvården upplevde nattens timmar på sjukhus. Till studien användes en kvalitativ metod med induktiv ansats, data inhämtades genom enskilda intervjuer med sju stycken patienter. Alla var inskrivna inom den vuxenpsykiatriska heldygnsvården. Intervjuerna var ostrukturerade med öppna frågor. Till analysarbetet tillämpades kvalitativ innehållsanalys enligt Graneheim och Lundman (2004). Resultatet delades in i fyra kategorier; källor till ro; saknad integritet; faktorer som kan störa sömnen och verktyg som hjälpmedel till sömn. Författaren diskuterar resultatet utifrån att främja sömnen för patienter inskrivna inom den vuxenpsykiatriska heldygnsvården. Vad vårdgivaren tillhandahåller innefattar både positiva och negativa omständigheter som påverkar patienternas sömn. Om vissa av dessa förhållanden kan förstärkas och vissa av dem kan reduceras kan det leda till att patienter inom den vuxenpsykiatriska heldygnsvården får en mer fullgod sömn och därmed en större chans till återhämtning, välbefinnande och hälsa.

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Mukhodobwane, Mukondeleli Talelani. « Attitudes towards healthy eating, a healthy lifestyle, and physical activity of healthcare professionals : A descriptive cross-sectional study in a public hospital in KwaZulu-Natal ». University of Western Cape, 2020. http://hdl.handle.net/11394/8055.

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Magister Scientiae (Nutrition Management) - MSc(NM)
In South Africa, healthcare professionals (HCPs) are at an increased risk of developing non-communicable diseases due to their unhealthy lifestyle behaviours, which mainly consist of excessive alcohol drinking and smoking, physical inactivity, and unhealthy diets. Attitudes towards healthy eating, a healthy lifestyle, and physical activity (PA) of individuals contribute towards individuals engaging in these health behaviours.

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Gullander, Hannah, et Sara Johansson. « The Effects of Installing Automated Ward Solutions for Medicine - A Case Study at Växjö Central Hospital ». Thesis, Linnéuniversitetet, Institutionen för ekonomistyrning och logistik (ELO), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-35165.

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Research Questions: Research Question I: How does the material management process of medicine differ between a ward with, and without, an Automated Ward Solution (AWS)? Research Question II: How do time and costs differ in the material management process of medicine between a ward with, and without, an AWS? Research Question III: How has the instalment of a central storage affected the number of orders placed for wards? Purpose: The purpose is to map and compare the material management process of medicine between a ward with, and without, an AWS. Further the mapped processes will be timed, allocated costs by applying TDABC and then compared. The purpose is as well to describe how the instalment of a central storage has affected the frequency of orders placed for wards. Methodology: This project is a qualitative case study as the authors wished to understand the phenomena of having installed AWSs for medicine in a real context. The primary data was collected through interviews, observations and studying of documents; the secondary data was collected through scientific articles and literatures. The collected data answered the research questions with the help of process mapping and TDABC. Conclusion: In the created process maps it is found that the extensiveness of the different processes when compared are similar for both wards; however the allocated costs calculated through TDABC sometimes differ due to the involvement of the Pharmaceutical Unit as it carries a higher capacity cost per minute. Ward 5 can be assumed to have a higher security and accuracy due to the instalment of an AWS and by having laid more responsibility on the Pharmaceutical Unit. The AWS has however led to a larger waste for Ward 5 as it cannot return regular medicine anymore. This project could not directly connect the instalment of a central storage with reduced order lines; however it can be assumed that it has contributed to the decreased order lines placed.

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Hartman, Linneá. « Smoking and Inflammatory Activity in Patients with Relapsing-Remitting Multiple Sclerosis : A retrospective review of medical history of patients withMultiple sclerosis at Karlstad Central hospital ». Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-66796.

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Saito, Irene Akamine. « Impacto da atividade física, da dieta e dos aspectos sociodemográficos e econômicos nos fatores de risco cardiovascular de trabalhadores de um hospital ». Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/89/89131/tde-17112015-170114/.

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INTRODUÇÃO: As doenças cardiovasculares (DCV) constituem a principal causa de morbimortalidade, impactando na saúde e na produtividade do trabalhador. Assim, identificar os fatores de riscos das DCV nos trabalhadores é de grande relevância, pois permite subsidiar ações educativas e intervenções direcionadas à redução desses. OBJETIVO: Avaliar o impacto do nível da atividade física, de componentes dietéticos e do perfil sociodemográfico e econômico nos fatores de risco para DCV de trabalhadores de um hospital. METODOLOGIA: Estudo transversal, observacional, com 280 funcionários de ambos os sexos, de três turnos de trabalho, de um hospital em SP. Aplicou-se questionários socioeconômico e clínico, de atividade física e de consumo alimentar, coletou-se exames bioquímicos, medidas antropométricas (peso, altura, circunferência da cintura), medidas de pressão arterial sistêmica e de impedância bioelétrica. Os dados de consumo alimentar foram corrigidos quanto à variabilidade intrapessoal e ajustado pela energia. Foram usados os testes estatísticos de qui-quadrado, Mann Whitney, Kruskall Wallis, regressão linear múltipla e modelos lineares generalizados, com nível de significância de p< 0,05 e IC=95%. RESULTADOS: O excesso de peso no sexo masculino foi de 66,3% e no feminino de 61,6%. A prevalência de dislipidemia, hipertrigliceridemia, HDL-baixo, síndrome metabólica, hipercolesterolemia isolada e hiperlipidemia mista, foram respectivamente: 54,3%; 16,8%; 18,9%; 13,4%; 7,5% e 3,1% . O sexo masculino apresentou um perfil mais aterogênico, maior consumo diário de calorias, lipídeos, carboidratos, proteínas e colesterol, porém teve um maior nível de atividade física no lazer e locomoção (ALL) e maior consumo de fibras. A ALL teve associação negativa com a CC (r²=0,062; p<0,001). A chance de um indivíduo com circunferência da cintura muito aumentada ter diabetes foi 4,2 vezes a de um indivíduo com CC normal ou aumentada (IC=1,3; 15.8). A média de triacilgliceróis foi 1,5 vezes maior (IC=1,3; 15.8) em portadores de CC muito aumentada que os de CC normal. Trabalhadores com CC muito aumentada, a média de LDL/HDL foi 1,31 vezes maior (IC=1,2;1,4%) que naqueles com CC normal ou aumentada. As chances de se ter hipertrigliceridemia foi 2,2 vezes maior (IC=1,1; 4,8) naqueles com renda familiar abaixo de 10 salários mínimos (SM), comparados aos que ganham mais de 10 SM. As chances de se ter hipertrigliceridemia foi 2,4 vezes maior (IC=1,2; 4,9) no sexo masculino, em relação ao feminino e aumentou conforme a idade. A razão LDL-C/HDL-C foi 1,3% (IC=1,2; 1,4) vezes maior em pessoas com CC muito aumentada, em relação a CC normal ou aumentada e também foi 1,3% (IC=1,2;1,4%) maior no sexo masculino que no feminino. CONCLUSÃO: Trabalhadores do sexo masculino, com maior idade, menor escolaridade e renda, tiveram maior risco cardiovascular. As pessoas que exerciam atividade física no lazer e locomoção apresentaram um perfil nutricional melhor e tiveram menos chances de terem dislipidemia e síndrome metabólica. A medida da CC foi o índice de adiposidade mais sensível em identificar as dislipidemias e o diabetes. O consumo alimentar de fibras e ω-3, se associaram a um melhor perfil nutricional, enquanto o consumo de gorduras trans e de colesterol, se associaram a um perfil pró-aterogênico.
INTRODUCTION: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality, affecting health and worker productivity. So identify the CVD risk factors in workers is of great importance because it allows support educational activities and interventions aimed at reducing these. OBJECTIVE: To evaluate the impact of level of physical activity, dietary components and socio-demographic and economic profile in risk factors for CVD of hospital workers. METHODOLOGY: Cross-sectional, observational study, with 280 employees of both genders, from three shifts in a hospital in SP. Applied socioeconomic and clinical questionnaires, physical activity and food intake, collected up biochemical tests, anthropometric measurements (weight, height, waist circumference), blood pressure measurements and bioelectrical impedance. The food consumption data were corrected for intrapersonal variability and adjusted for energy. They used the statistical test Chi-square, Mann Whitney, Kruskal Wallis, multiple linear regression and generalized linear models, with a significance level of p <0.05 and 95% CI. RESULTS: Overweight among men was 66.3% and female 61.6%. The prevalence of dyslipidemia, hypertriglyceridemia, low HDL, metabolic syndrome, isolated hypercholesterolemia and mixed hyperlipidemia, were, respectively, 54.3%; 16.8%; 18.9%; 13.4%; 7.5% and 3.1%. Males had a more atherogenic profile, higher daily consumption of calories, lipids, carbohydrates, proteins and cholesterol, but had a higher level of physical activity in leisure and locomotion (ALL) and higher fiber intake. ALL had a negative association with CC (r² = 0.062; p <0.001). The chance of an individual with very large waist circumference have diabetes was 4.2 fold that of an individual with normal or increased DC (CI = 1.3, 15.8). The average triglycerides was 1.5 (CI = 1.3, 15.8) greatly increased in patients with CHD the normal DC. Workers with greatly increased DC, the mean LDL / HDL ratio was 1.31 times (CI = 1.2, 1.4%). higher than those with normal or increased DC. The chances of having hypertriglyceridemia was 2.2 fold that (CI = 1.1, 4.8) in those with a family income below 10 minimum wages (SM), compared to those who earn more than 10 SM. The chances of having hypertriglyceridemia was 2.4 fold (CI = 1.2, 4.9) in males, compared to females and increased with age. The LDL-C / HDL-C was 1.3% (IC = 1.2, 1.4) fold in individuals with greatly increased CC in relation to normal or enhanced DC and it was also 1.3% (CI = 1.2, 1.4%) higher in males than in females. CONCLUSION: Male workers with higher age, lower education and income, had higher cardiovascular risk. People who practiced leisure physical activity and locomotion had a better nutritional profile and were less likely to have dyslipidemia and metabolic syndrome. WC measurement was the most sensitive adiposity index in identifying dyslipidemia and diabetes. Dietary fiber intake and ω-3, were associated with a better nutritional profile, whereas the consumption of trans fats and cholesterol, were associated with a pro-atherogenic profile.

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Marin, Marcia Lucia de Mario. « Modelagem e implantação de sistema de informações para monitorar custo de produção dos produtos fabricados pela Farmácia Hospitalar do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo ». Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/9/9139/tde-22032010-162849/.

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A partir do método de custeio por absorção, com adaptação do custeio baseado em atividades, um sistema de informações foi modelado e implantado para monitorar custo de produção, dos produtos fabricados pela farmácia hospitalar do Hospital das Clínicas da Faculdade de Medicina da USP. Foram analisados os formulários dos produtos fabricados, insumos, gastos indiretos de fabricação, controle de qualidade e totalizados os tempos gastos da mão-de-obra direta de 100 produtos fabricados em julho de 2003. Os resultados mostraram que de 35 itens produzidos com similares, 28 apresentaram custo de produção inferior ao preço do fabricante no mercado, estimando que nesse mês o HC deixou de gastar, aproximadamente, 750 mil reais com a produção interna. Os 65 itens restantes eram produtos exclusivos e especiais. Os gastos com insumos corresponderam a 69% do custo total de produção. O modelo proposto mostrou que a farmácia hospitalar pode proporcionar redução de gastos à entidade.
On the basis of the absorption costing method, with a number of adaptations from activity based costing, an information system was modeled and implanted to monitor the production costs of products manufactured by the hospital pharmacy of Hospital das Clínicas, Faculty of Medicine, University of São Paulo. Were analysed manufactured products forms, raw material, indirect manufacturing costs, quality control, and added up direct labor time for 100 manufactured products in July 2003. The results showed that out of 35 items produced with similar products in the market, 28 presented a production cost below the price of the market manufacturer. Evaluations revealed that, during this month, the institution saved about 750 thousand reais through internal production. The 65 remaining items were exclusive and special products. Raw material expenses accounted for 69% of total production costs. The proposed model showed that the hospital pharmacy can lead to expense reduction for the entity.

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Souza, Vera Lúcia Inácio de. « Entre intensidades do trabalhar : uma clínica da atividade nas tramas da Oficina de Criatividade do Hospital Psiquiátrico São Pedro ». reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/55411.

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Esta dissertação aborda o encontro entre fazeres intensivos que envolvem o trabalhar, o pesquisar e o ativar-se, buscando ser, sob cada instante presente, uma linha delicada entre fazer e pensar a atividade que fazemos. Por essa via, nosso problema de pesquisa percorre as expressividades que surgem co-implicadas nos mais imperceptíveis gestos e palavras que compõem os fazeres que realizam e desrealizam, através de um real da atividade capaz de incitar o pensar e o agir, sobretudo, pelas intensidades que advém de um território. Acerca deste, situamos a pesquisa junto aos trabalhadores da Oficina de Criatividade do Hospital Psiquiátrico São Pedro, o que se faz em indissociabilidade entre usuário, pesquisadora e o agenciamento que os produz. Nesse percurso, tomamos a atividade, a partir dos campos da Clínica da Atividade e da Ergologia, como uma intercessora para compor e desdobrar as expressividades dos modos de trabalhar. Para tanto também discorremos, sobretudo, através do conceito de territorialização, advindo da Filosofia da Diferença, em que se engendra um tempo que se repete, passível de ser amplificado em sua potência de diferir. Como procedimentos metodológicos, propomos um Dispositivo Clínico-Institucional de Análise da Atividade, em que suas linhas desdobram-se através da escrita da pesquisa, do acompanhamento das situações de trabalho e da análise coletiva da atividade. Pinçamos movimentos em desterritorialização, vislumbrando um plano comum de análise da atividade, através do qual se tornam visíveis algumas de nossas problemáticas, entre as quais, a indiscernibilidade da imagem, da loucura, dos enunciados e gestos que se contraem e se expandem sob os modos de trabalhar; as territorializações de um gênero (multi)profissional e suas estilizações - entre cuidado, expressão e clínica- no encontro com usuários, componentes arquitetônicos e, sobretudo, com os movimentos da reforma psiquiátrica; e, as análises da atividade coletiva como instrumento sutil e amplificador das ações do coletivo de trabalho. Por essas vias, tramamos essa escrita com vistas a fazer proliferar a potência clínica de uma memória coletiva do trabalho e, também, apostando no que segue diferindo, sob cada instante móvel, no cotidiano das vidas que se produzem nesse território.
This thesis focuses on the intersectionality of intensive processes involving work activity, research activity and a self reflexive ethical activity, by looking forward to trace the tenuous line between act and thought of the performed activity. In this way, this research highlights the expressivities that emerge in a co-implied interaction co-implied in the most untraceable gestures and words which compose the set of tasks that perform and des-held the activity itself. The real activity is able to incite thinking and acting processes, through the intensities conferred by a territory. Having this in mind, this research deals with a specific group of workers. They are workers of a Creative Workshop situated in the Psychiatric Hospital São Pedro. It is also important to stress the intertwined relations that involves this specific group of workers, the final user of mental care, the researcher and the agency that produces the research scene itself. In this study, the activity is understood through the framework proposed by Ergology and Clinic of Activity, this in order to compose and trace the expressivities that are inherent regarding pluralistic modes of work. Taking this aim into consideration, I highlight as well the important role played by the concept of territorialization - from Philosophy of Difference -, which enable us to see how a time is engendered in repetition, which can be amplified concerning its potential of differing. As methodological procedures, I propose a clinic-institutional device for the analysis of activity. This method implies on the research writing process itself, the field work conducted through observation of work situations and a focused group analysis of this workers. This research aims to track the deterritorialization movements performed by this group of workers, envisioning a common plan of activity analysis, through which some of the problematics become visible, including an indiscernibility of image, madness, statements and gestures which can be expanded or contracted regarding the different ways of working. In addition, I would like to put in evidence (multi) professional territorializations and its esthetics - between care, expression and clinic- regarding the encounter with mental care users, architectural aspects and the movements of the psychiatric reform in Brazil. Moreover, I also stress the relevance of the collective analysis of activity, since it emerged as an important subtle tool concerning the actions and elaborations produced within the group. Taking all these elements into consideration, this study aims to proliferate the clinical potential expressed by a collective memory of work, by highlighting the points of difference considering the daily life produced by this territory.

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Rocha, Leticia Santos da. « Sistema de custeio baseado em atividades para gerenciamento do processo de manutenção de equipamentos medico-assistenciais ». [s.n.], 2005. http://repositorio.unicamp.br/jspui/handle/REPOSIP/260546.

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Orientador: Jose Wilson Magalhães Bassani
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Eletrica e de Computação
Made available in DSpace on 2018-08-05T12:39:44Z (GMT). No. of bitstreams: 1 Rocha_LeticiaSantosda_D.pdf: 931669 bytes, checksum: a042ec9b535989c70d7e76efd1b732dc (MD5) Previous issue date: 2005
Resumo: O Centro de Engenharia Biomédica (CEB) da Universidade Estadual de Campinas (UNICAMP) gerencia as atividades de manutenção (corretivas e preventivas) de um parque de cerca de 10.000 equipamentos médicos da área de saúde da Universidade, que inclui dois hospitais, dois centros médicos e uma escola de medicina. Para controlar estes serviços, o setor de Engenharia Clínica do CEB possui um sistema de gerenciamento baseado em uma máquina de estados, no qual todas as ordens de serviço (OS) são caracterizadas por trajetórias compostas pelos estados pelos quais cada OS passa durante a sua execução. Os estados são microprocessos ativados para solução de tarefas específicas. Cada mudança entre microprocessos é denominada, neste sistema, transicão. A nossa hipótese de trabalho foi que seria possível implementar no CEB um método de cálculo do custo das OS utilizando a técnica de custeio por atividade (Activity Based Costing, ABC). Para testar esta hipótese, tomamos as atividades (unidades fundamentais para a composição do custo ABC) equivalentes às transicões. Com esta abordagem fomos capazes de extrair o custo ABC das ordens de serviço, calcular o custo dos serviços prestados, exercitar o conceito de lucratividade (simulando valores de venda para cada OS com base no mercado), explicitar os custos das atividades dos indivíduos dentro dos diversos setores do CEB e estudar o impacto sobre o serviço (conjunto de atividades) de um determinado excedente "planejado", mediante o oferecimento de serviços para o mercado. Tendo em vista a possibilidade de calcular lucros para cada tipo de OS, pudemos estudar a aplicação de um processo de decisão, usando a técnica processo de hierarquia analítica (Ana/ytic Hierarchy Process, AHP) para decidir sobre a escolha da manutenção feita por terceiros ou feita pela equipe da casa. Os exercícios de cálculo de custos em diferentes condições ilustram a possibilidade de uso do ABC para gerenciamento baseado em atividade (Activity Based Management, ABM) e resultaram valores compatíveis com a realidade do sistema público universitário de saúde (e.g. custo das OS, custo do trabalho e atividades no CEB). Concluímos que a estratégia adotada de equivalência entre atividades e transições viabiliza e facilita a implementação do sistema ABC (o que confirma a nossa hipótese) e que, tendo em vista os preços praticados no mercado, um excedente da venda de serviço pode ser gerado, mesmo em um sistema público de saúde como o da UNICAMP, no qual os custos, essencialmente fixos (e.g. pessoal, depreciação, custos gerais), não podem ser reduzidos de modo trivial
Abstract: The Center for Biomedical Engineering (CEB) at 8tate University of Campinas (UNICAMP) manages the maintenance activities (corrective and preventive) of about 10,000 medical devices for the health care area of the university, which is comprised by two hospitais, two medical centers and a medicine school. In order to control these maintenance activities, the Clinical Engineering department makes use of a state machine-based management system in which the service orders (80) are characterized by trajectories (sequence of states) constructed while the 80 is processed. The states are microprocesses, which are activated to solve specific tasks. Each transition between two microprocesses (the state transition) is named, in short, a transition. We worked under the hypothesis that it would be feasible to implement at CEB a method for 80 costing based on the Activity-Based Costing (ABC) technique. To test our hypothesis, we made activity, fundamental token for ABC, equivalent to transition. With this approach, we were able to extract the ABC cost of each 80, to estimate cost for a specific service proposal, to exercise the concept of profitability by simulating selling costs for each 80 based in the current market, to explicit activity costs for individual jobs in CEB, and to study the impact of offering external services upon the total amount of activities of a certain "planned profit". By the analysis of 80 involving third party services, we studied the possibility of using the Analytic Hierarchy Process (AHP) technique to choose between third party or in-house services. The different conditions of ABC application in the present work iIIustrated the possibility of using ABC for Activity-Based Management (ABM), with results compatible with the expected figures for a public university health system (which validated our hypothesis). We conclude that our strategy of equivalence between activity and transition made the ABC feasible and relatively simple. We also found that according to the current market prices it is possible to envisage profit even in a health system such as in UNICAMP, in which costs are essentially fixed (e.g. staff, depreciation, general costs)
Doutorado
Engenharia Biomedica
Doutor em Engenharia Elétrica

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Beltrame, Marlize Tatsch. « HÁBITOS SAUDÁVEIS E CAPACIDADE PARA O TRABALHO EM TRABALHADORES DO SERVIÇO HOSPITALAR DE LIMPEZA ». Universidade Federal de Santa Maria, 2014. http://repositorio.ufsm.br/handle/1/7406.

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This study aimed to evaluate the relation between healthy habits and work ability of hospital cleaning staff in a university hospital from Rio Grande do Sul. It is a cross-sectional research with quantitative approach developed with 157 workers, from March to April 2013. It was used the Perception of Healthy Habits Questionnaire (QPHAS), and the Brazilian version of Index of Work Capacity (ICT). Data analysis was developed on the software PASW 18.0, through descriptive and multivariate statistics. It was found 87.9% of workers to be female, aged average 39,9 years old (±9,8); 38,9% with high school education; average of family income per capita lower than the national minimum wage (average 0.86 (±0.47), minimum of 0.20 and maximum 2.95 wages); 65.6% cleaning servants; 4.4%, Material cleaning helpers; with an average of 32.5 months (±48.9) of working at the institution; 58.6% needed medical assistance last year, 6.4%, of psychological following and 51% used medication. Regarding to perception of healthy habits, 67.5% of the workers had high perception. Dimensions in body weight control, diet and physical activity QPHAS, respectively, 70.7%, 73.9% and 68.8% showed high awareness of healthy habits. With respect to capacity for the current job, 36.6% identified as 10 score perceived , in relation to the physical and mental demands 44.4% and 63.5% respectively showed how good the current capacity to work, 29.9% showed no disease diagnosed by a physician, 56.1% reported not having impediment to his current work in relation to their illness or injury, 56.7% showed no absence from work; 77.7% reported the ability to be good two years from now they can play their current job, 54.8% reported being always satisfied with the daily activities of their work, 71% reported feeling constantly full of hope for the future; 79.6% had good/great capacity for work, and 20.4% low/moderate. Revealed a low positive correlation between ICT and power dimensions (r = 0.174, p = 0.029) and physical activity (r = 0.207, p = 0.009) and overall score QPHAS (r = 0.179, p = 0.025). After adjustment for confounding factors (p <0.25) factors, not having time for leisure was associated with reduced work ability (OR = 2.26, 95% CI 1.268 to 4.015, p = 0.006). These results can inform the planning of promotion and prevention of health hazards to workers Housekeeping, Hospital, contributing to the maintenance of work ability.
Este estudo objetivou avaliar a associação entre hábitos saudáveis e capacidade para o trabalho nos trabalhadores do Serviço Hospitalar de Limpeza de um hospital universitário público do Rio Grande do Sul. Trata-se de uma pesquisa transversal com abordagem quantitativa realizada com 157 trabalhadores, no período de março a abril de 2013. Utilizaram-se o Questionário de Percepção de Hábitos Saudáveis (QPHAS) e a versão brasileira do Índice de Capacidade para o Trabalho (ICT). A análise dos dados foi realizada no programa PASW 18.0, por meio da estatística descritiva e multivariada. Encontraram-se 87,9% de trabalhadores do sexo feminino, com idade média de 39,9 anos (±9,8); 38,9% com ensino médio completo; renda familiar per capita média menor que um salário mínimo nacional (média 0,86 (±0,47), mínimo de 0,20 e máximo de 2,95 salários); 65,6% Serventes de Limpeza; 34,4%, Auxiliares de Limpeza de Materiais; com tempo médio de trabalho na instituição de 32,5 meses (±48,9); 58,6% necessitaram de atendimento médico no último ano; 6,4% de acompanhamento psicológico e 51% faziam uso de medicação. Em relação à percepção de hábitos saudáveis, 67,5% dos trabalhadores apresentaram alta percepção. Nas dimensões controle do peso corporal, alimentação e atividade física do QPHAS, respectivamente 70,7%, 73,9% e 68,8% apresentaram alta percepção de hábitos saudáveis. Em relação à capacidade para o trabalho atual, 36,6% apontaram 10 como pontuação percebida; em relação às exigências físicas e mentais 44,4% e 63,5% respectivamente apontaram como boa a capacidade atual para o trabalho; 29,9% não apresentaram nenhuma doença diagnosticada pelo médico; 56,1% referiram não ter impedimento para o seu trabalho atual em relação às suas doenças ou lesões; 56,7% não apresentaram nenhuma falta ao trabalho; 77,7% referiram ser boa a possibilidade de daqui a dois anos conseguirem desempenhar o seu trabalho atual; 54,8% referiram estarem sempre satisfeitos com as atividades diárias de seu trabalho; 71% referiram sentir-se continuamente cheios de esperança para o futuro; 79,6% apresentaram boa/ótima capacidade para o trabalho, e 20,4%, baixa/moderada. Evidenciou-se correlação positiva baixa entre o ICT e as dimensões alimentação (r=0,174; p=0,029) e atividade física (r=0,207; p=0,009) e no escore geral do QPHAS (r=0,179; p=0,025). Após ajustes por fatores de confundimento (p<0,25), não ter tempo para o lazer se mostrou associado à redução da capacidade para o trabalho (OR=2,26; IC95%=1,268 4,015; p=0,006). Estes resultados podem subsidiar o planejamento de ações de promoção e de prevenção de agravos à saúde dos trabalhadores do Serviço Hospitalar de Limpeza, contribuindo para a manutenção da capacidade para o trabalho.

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Furuseth, Christina, et Therese Samuelsson. « Beskrivning av patienters postoperativa vårdförlopp tre dagar efter kolorektalkirurgi enligt ERAS vårdprogram ». Thesis, University of Gävle, University of Gävle, Faculty of Health and Occupational Studies, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-7547.

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Abstract

The purpose of this study was to describe the post-operative care during the three first days for patients who have undergone colorectal surgery according to ERAS care programs with a focus on the variables nutrition, elimination, activity, type of analgesia and the number of hospital days documented in the patient record and patient log books. ERAS means "Early Recovery After Surgery" and the purpose of the health care program is to accelerate recovery after colorectal surgery. The study had a descriptive design and a quantitative approach, in which 51 patient records were included. Log books and patient records were reviewed postoperatively. According to the log books estimated most of the patients, who had documented, that they ate and drank very good or good. According to nursing documentation most of the patients ate ordinary food and drank nutritional drinks. According to the log books, the mean and median were about two drinks per day while nursing documentation varied. According to the log books, the median first stool after surgery was two days and according to the nursing documentation three days. The median number of walks in the corridor varied from 2-3 (log books) to two walks each day (nursing documentation). Epidural analgesia was the most common analgesia. The mean number of hospital days was 8.4 days (median 7 days). The conclusion is that few ERAS patients achieved the targets set at the hospital. The lack of documentation makes the interpretation difficult.

Sammanfattning

Syftet med studien var att utifrån sjuksköterske- och patientdokumentation beskriva det postoperativa vårdförloppet under tre dagar för patienter som har genomgått kolorektalkirurgi enligt ERAS vårdprogram med fokus på variablerna nutrition, elimination, aktivitet, typ av smärtlindring och antal vårddagar. ERAS betyder "Early Recovery After Surgery" och syftet med vårdprogrammet är att påskynda återhämtning efter kolorektalkirurgi. Studien hade en beskrivande design och en kvantitativ ansats där 51 patientjournaler inkluderades. Loggböcker och patientjournaler granskades postoperativt. Enligt loggböckerna så skattade de flesta patienterna, av de som hade dokumenterat, att de åt och drack mycket bra eller bra. Enligt sjuksköterskedokumentationen så åt de flesta vanlig mat och drack näringsdrycker. Enligt loggböckerna var medelvärdet och medianen cirka två näringsdrycker per dag medan det enligt sjuksköterskedokumentationen varierade. Enligt loggböckerna var medianen för första avföringen efter operationen två dagar och enligt sjuksköterskedokumentationen tre dagar. Medianen för antal vändor i korridoren varierade från 2-3 vändor (loggböckerna) till 2 vändor varje dag (sjuksköterske-dokumentationen). Epiduralbedövning var den vanligaste smärtlindringen. Medelvärdet för vårddagar var 8,4 dagar (median 7 dagar). Slutsatsen är att få patienter uppnådde de uppsatta målen vid det aktuella sjukhuset. Dokumentationen var bristfällig, vilket försvårar tolkningen av resultatet.

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40

Lima, Carlos Rogério Montenegro de. « Activity-based costing para hospitais ». reponame:Repositório Institucional do FGV, 1997. http://hdl.handle.net/10438/4698.

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This dissertation presents the conventional cost accounting systems described in specialized literature. It also discusses three costing methods used by healthcare provider organizations in United States. It presents the basic contents about activitybased costing (ABC) anda framework for its implementation . It concludes with an ABC model for hospitais.
Esta dissertação de mestrado apresenta os métodos convencionais de custeio descritos na literatura. Também discute os método de custeio mais utilizados pelos serviços de saúde norte-americanos. Apresenta a fundamentação teórica e descreve um método de aplicação do Sistema de Custos Baseado em Atividades (ABC - Activity-Based Costing). Conclui mostrando um exemplo prático da aplicação do Activity-Based Costing em um hospital

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41

Matějovicová, Ivana. « Zjišťování nákladové náročnosti hospitalizačního případu ». Master's thesis, Vysoká škola ekonomická v Praze, 2016. http://www.nusl.cz/ntk/nusl-264657.

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The thesis, Survey of the methods of costing of hospitalization, deals with the characteristics of the classification system DRG used for costing of hospitalization. The first half of the theoretical part of this work describes the Czech health care in general and specific ways of financing it. We focus on the costs related to the emergency care in hospitals which are classified by the DRG system. The second half of the theoretical part studies the actual principles of costing of hospitalization. The method chosen for this is called Activity Based Costing (ABC). It defines the procedures of costing which are being used in hospitals. At the end, we provide a description of the current and suggested procedures of costing of hospitalization and how they are utilized to set up parameters of the reimbursing mechanism. The practical part of this thesis maps the situation of hospitalization financing in Klatovska nemocnice, a. s. We suggest a new way of financing based on the methodology DRG Restart. Base on the data obtained in Klatovska nemocnice, a. s. we summarize and compare the results of the new method to the current one.

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42

Petit, Nicolas. « Le contrôle de gestion logistique hospitalier : pratiques de performance et modélisation des coûts en TDABC ». Phd thesis, Université Rennes 1, 2013. http://tel.archives-ouvertes.fr/tel-00938271.

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De nombreuses recherches sont effectuées dans le domaine de la santé et concernent plus particulièrement les hôpitaux. Ceux-ci sont de vastes organisations et recensent de multiples métiers, de nombreuses activités autres que celle du soin apporté au patient. L'originalité de cette recherche consiste à se positionner vis-à-vis de l'une des fonctions support, la logistique hospitalière, et d'analyser en quoi celle-ci peut contribuer à l'amélioration de la performance financière de nos hôpitaux, ainsi qu'à la résolution des défis de nature économique qui lui sont posés. Cette thèse étudie d'abord comment définir et évaluer la performance logistique hospitalière. Elle analyse également les outils de gestion traitant de la performance logistique présents au sein des établissements de santé français. Suivent des monographies de nature exploratoire et une étude statistique auprès d'une centaine de responsables logistiques d'hôpitaux afin d'observer les pratiques développées et les difficultés rencontrées par ces professionnels. Nous appliquons enfin la méthode Time-Driven Activity Based Costing au service de transport d'un établissement ; des équations de temps nous permettent d'affiner les coûts et optimisent le contrôle de gestion opérationnel de l'activité logistique. Les réponses apportées par le contrôle de gestion aux lacunes observées au sein de la littérature et exprimées dans l'étude statistique sont analysées

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Cardoso, Neto José Olímpio. « Avaliação da aplicabilidade do custeio baseado em atividades : um estudo comparativo em hospitais filantrópicos do município de São Paulo ». Pontifícia Universidade Católica de São Paulo, 2012. https://tede2.pucsp.br/handle/handle/1505.

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This dissertation presents the results of a descriptive study on the applicability of activity-based costing (ABC) in philanthropic hospitals in São Paulo. Initially, the study is produced from literature searches, constituting the foundation of the theoretical underpinning of the work. Aiming at increasing the information about the time visits were made in a philantropic hospital, seeking to understand the shape and importance of monitoring hospital costs experienced in daytoday these hospitals. In this intermediate phase interviews were conducted with hospital managers, facing the daily production of the hospitals. These steps were critical to completing the questionnaire to be applied in the research. We selected three hospital organizations outside the target population to achieve the pre-test. To achieve the objective of the study was a questionnaire, with almost dichotomous questions (closed) and multiple choice. The results revealed that the majority of the sample does not use the activitybased costing, and the determining factor for not using this methodology the understanding that: the current costing system meets the organization, followed by cost / benefit profile for use , and the high complexity of applying the ABC. However, in some organizations is being studied to apply this methodology. Considering also the results obtained in the research, there is an organization that applied the concepts of the methodology throughout the hospital, having deployed the ABC over a period exceeding three years, and currently uses a methodology that maps the time and resources involved in the processes without entering the mapping of all the activities themselves
Esta dissertação apresenta os resultados de um estudo descritivo sobre a aplicabilidade do custeio baseado em atividades (ABC), nos hospitais filantrópicos da cidade de São Paulo. Inicialmente, o estudo é produzido a partir de pesquisas bibliográficas, constituindo-se no alicerce da sustentação teórica do trabalho. Esta visa ampliar as informações a respeito do tempo em que foram realizadas as visitas em um hospital filantrópico, buscando entender a forma e a importância do monitoramento dos custos hospitalares vivenciada no diaadia desses hospitais. Na fase intermediária foram realizadas entrevistas com gestores hospitalares, voltadas ao cotidiano produtivo dos hospitais. Esses passos foram de suma importância para a realização do questionário a ser aplicado na pesquisa. Foram selecionadas três organizações hospitalares não pertencentes à população-alvo para a realização do pré-teste. Para atingir o objetivo do estudo foi aplicado um questionário, com praticamente questões dicotômicas (fechadas) e de múltipla escolha. Os resultados revelaram que a maior parte da amostra não utiliza o custeio baseado em atividades, sendo o fator determinante para a não utilização dessa metodologia o entendimento que o atual sistema de custeio atende à organização; seguido da relação custo/benefício desfavorável para a sua utilização e, por último, da alta complexidade em aplicar o ABC. Porém, em algumas organizações está em fase de estudos a aplicação dessa metodologia. Considerando ainda os resultados obtidos na pesquisa, existe organização que aplicou os conceitos da metodologia em todo o hospital, tendo implantado o custeio ABC em um período superior a três anos e que, atualmente, utiliza uma metodologia que mapeia os tempos e os recursos envolvidos nos processos, sem entrar no mapeamento de todas as atividades propriamente ditas

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44

Neyton, Clément. « Évaluation de l’hémodynamique systémique lors de l’arrêt cardiaque par analyse des signaux recueillis par un défibrillateur ». Thesis, Strasbourg, 2018. http://www.theses.fr/2018STRAJ062.

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Afin d’apporter les soins adéquats aux victimes d'arrêt cardiaque extrahospitalier, l'évaluation de leur état hémodynamique est primordiale. La prise de pouls manuelle ne permet pas une identification fiable de l'arrêt cardiaque par les profanes ou une discrimination des rythmes organisés par les premiers intervenants. Dans ce contexte, l'entreprise Schiller Médical a cherché à intégrer dans sa gamme de défibrillateurs un module de détection de l'hémodynamique systémique par analyse de l'électrocardiogramme et des variations d'impédance transthoracique recueillis via les électrodes de défibrillation. Ce travail de recherche mené en partenariat entre l'entreprise Schiller Médical et l'Institut Pluridisciplinaire Hubert Curien de l’Université de Strasbourg a consisté dans un premier temps a recherché, lors d'arrêt cardiaque induit électriquement chez l'homme, des descripteurs des variations d'impédance transthoracique marqueurs de l’hémodynamique systémique. L’identification des descripteurs les plus pertinents a par la suite permis de construire des modèles prédictifs des défaillances circulatoires. Nous avons mis en lumière des limites à l’utilisation des variations d’impédance transthoracique. Elles sont prises en considération pour la documentation des interventions extrahospitalières destinée à l’apprentissage des algorithmes de classification des rythmes perfusants et rythmes sans pouls
Providing suitable emergency care during out of hospital cardiac arrest requires the diagnostic of the circulatory status. Manual pulse check does not provide a reliable way for laypersons to identify cardiac arrest or for first responders to discriminate organized rhythms. Thus, Schiller Medical sought to embed an hemodynamic sensor in its external defibrillators by analyzing the electrocardiogram and transthoracic impedance recorded via the defibrillation pads. This thesis work stemmed from a partnership between Schiller Medical and the Institut Pluridisciplinaire Hubert Curien of the Université de Strasbourg. We first identified transthoracic impedance featureslinked with the circulatory status by studying clinically induced cardiac arrest. The most relevant features were later selected to form predictive models of hemodynamic collapse. We uncovered restrictions to the use of transthoracic impedance. We took them into account for the annotation of out of hospital cardiac arrests aimed at training algorithms for the classification of pulseless electrical activity and pulsatile rhythms

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45

Shapiro, Janet. « Simulation modelling of spatial problems ». Thesis, London Metropolitan University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.294985.

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Barkenbush, Mark Joseph 1962. « A database system for managing the clinical activity of the faculty and residents of the Department of Anesthesiology at University Medical Center ». Thesis, The University of Arizona, 1987. http://hdl.handle.net/10150/276636.

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A computerized data base system for managing clinical activity of faculty and residents has been developed and tested in The Department of Anesthesiology, University Medical Center, Tucson, AZ. Using d-Base III+ and an IBM PC AT the system provides the department residents with tabulated data on a monthly and year-to-date basis, which can be easily transposed onto annual clinical activity reports required by The American Board of Anesthesiology. The system maintains a clinical activity history for the faculty, which allows for equitable work scheduling. The system also tabulates anesthesia equipment usage and problems. The system has been in operation since October, 1987 with residents and faculty receiving clinical activity reports on a monthly basis. System operation requires 10 to 12 hours of secretarial time weekly.

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47

Martín, Raquel de Lourdes. « Activina A, Inhibina A, PP13 y PAPP-A ». Master's thesis, Universidad Nacional de Cuyo. Facultad de Ciencias Médicas, 2016. http://bdigital.uncu.edu.ar/8271.

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La preeclampsia (PE), es un proceso mórbido específico, multisistémico e idiopático de la gestación y del puerperio humano. Se produce en el 3-14 % de todos los embarazos, en el 30% de las gestaciones múltiples, en el 30% de los embarazos en mujeres diabéticas, y en el 20% de las gestaciones en las mujeres con hipertensión crónica. Sin embargo, dos tercios de todos los casos ocurren en embarazadas que, fuera de este desorden, son nulíparas sin otras complicaciones aparentes. Mundialmente, se atribuyen más de 100.000 muertes maternas al año por la aparición de PE y eclampsia (convulsiones o coma coincidente en una paciente con PE), asociándose a una mortalidad perinatal y neonatal de hasta el 10%. Esta enfermedad se clasifica en I) PE Leve (valores de TA iguales o mayores a 140/90 mmHg, en dos ocasiones separadas por al menos cuatro horas, con proteinuria igual o superior a 300 mg/24 horas); II) PE Severa (valores de TA iguales o mayores a 160/110 mmHg o aún con valores tensionales menores, pero asociados a uno o más de los siguientes eventos clínicos: proteinuria > de 5 g/24 horas, alteraciones hepáticas, hematológicas, de la función renal, neurológicas, visuales, restricción del crecimiento intrauterino/oligoamnios, desprendimiento de placenta, edema agudo de pulmón (no atribuible a otras causas). Se manifiesta en general desde la vigésima semana del embarazo, durante el parto y el puerperio. Excepcionalmente puede presentarse antes de las 20 semanas en pacientes con Enfermedad Trofoblástica Gestacional o Síndrome Antifosfolipídico severo. Por ello, un desafío actual de la obstetricia sigue siendo el detectar tempranamente el riesgo de desarrollar PE. La PE tiene dos etapas: una primera etapa asintomática, local, en la cual hay un estado hipóxico de la placenta, lo que determina una injuria de la misma, y una segunda etapa, sintomática, caracterizada por una reacción inflamatoria sistémica exagerada y una disfunción endotelial. Entre estas dos etapas existen moléculas producidas por la placenta que son capaces de difundir este daño placentario y convertirlo en un compromiso sistémico. Durante los últimos años, diversas hormonas y proteínas fueron evaluadas como 2 posibles marcadores de la enfermedad; sin embargo, no han sido utilizados en nuestro medio por lo que representa un área pendiente de estudio. El objetivo general es la identificación precoz de las mujeres embarazadas que desarrollarán PE. La hipótesis propuesta es que la determinación de la concentración sérica de Activina A, Inhibina A, PP13 y PAPP-A es útil para predecir la aparición y gravedad de PE a partir de las 20 semanas de gestación. Los objetivos específicos son: 1) Determinar la concentración sérica de Activina A, Inhibina A, Proteína Placentaria 13 y Proteína A Plasmática Asociada al Embarazo en el primer y segundo trimestre de embarazo. 2) Correlacionar los niveles séricos de las proteínas estudiadas con el desarrollo de PE. 3) Correlacionar los niveles séricos de las proteínas estudiadas con la gravedad de la enfermedad. Se incorporaron en el protocolo de estudio 92 mujeres gestantes pertenecientes a la población general que se controlaron en la Maternidad “José Federico Moreno" del Hospital “Luis Lagomaggiore". A cada paciente embarazada se le realizó la extracción de 10 ml de sangre periférica en un tubo seco con 8 h. de ayuno entre las 10 a 12 semanas y 17 a 20 semanas. La realización del estudio se efectuó en todo momento de acuerdo a las normas de buena práctica clínica con plena aceptación de las normas éticas vigentes. El proyecto y el correspondiente consentimiento informado fueron evaluados y aprobados por el Comité de Ética del Hospital “Luis Carlos Lagomaggiore". Se empleó la técnica de ELISA (Inmunoensayo enzimático test) utilizando los siguientes kits comerciales: Abcam AB113316 para Activina-A, Beckman Coulter DSL-10-10800 para Inhibina A, MBS700610 para PP13 y Beckman Coulter DSL-10-27100 para PAPP-A. Los principales resultados fueron: 1. El valor medio en suero materno de la Proteína Placentaria 13 disminuyó en el primer trimestre (10-12 semanas de gestación) en las mujeres que desarrollaron PE en comparación con el grupo control (p=0.02). Esta proteína alcanzó diferencia estadísticamente significativa en el grupo que desarrolló PE leve en el mismo trimestre (p=0.014). 2. El valor medio en suero materno de inhibina-A disminuyó en el segundo trimestre (17-20 semanas de gestación) en las mujeres que desarrollaron PE en comparación con el grupo control (p=0.04). Este marcador, alcanzó diferencia estadísticamente significativa en el grupo que desarrolló PE leve (p=0.03) en el mismo trimestre. 3. El valor medio en suero materno de Proteína Placentaria Asociada al Embarazo A aumentó en el segundo trimestre (17-20 semanas de gestación) en las mujeres que desarrollaron PE en comparación con el grupo control (p=0.0308). Este marcador alcanzó diferencia estadísticamente significativa en el grupo que desarrolló PE leve (p<0,05) en el mismo trimestre. 4. La determinación de Activina A no presentó diferencias estadísticamente significativas entre el grupo control y el que desarrolló PE. 5. Los valores de tensión arterial media superiores o iguales a la media de 80,39 mmHg durante el primer trimestre (10-12 semanas) de embarazo debería considerarse un parámetro útil para la predicción de PE. 6. Los valores de índice de masa corporal superiores o iguales a la media de 28,31 durante el segundo trimestre (17-20 semanas) de embarazo debería considerarse un parámetro útil para la predicción de PE. 3 Los resultados presentados en la presente investigación son los primeros que existen en nuestra región. Dado que la PE sigue siendo un problema con gran impacto en salud perinatal y causa directa de muerte materna, consideramos que al ampliar el número de pacientes estudiadas se podría arribar a conclusiones representativas sobre la utilidad del dosaje de estos marcadores moleculares, sobre todo en el primer trimestre de la gestación, adelantándonos al diagnóstico clínico de la enfermedad. Los datos aportados por este estudio marcan un hito en el estudio de PE en nuestro medio.
Fil: Martín, Raquel de Lourdes. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas.

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Bonache, Adrien. « Contrôlabilité et complexité : Essai sur la plausibilité de lectures formelles et informelles ». Thesis, Montpellier 2, 2011. http://www.theses.fr/2011MON20098.

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Objectif – Cette thèse vise à montrer dans quelle mesure les membres d'une organisation peuvent contrôler des situations de gestion complexes. Cette question de recherche est traitée en adoptant deux angles d'analyse. D'une part, nous considérons les liens entre contrôlabilité et complexité, sous l'angle formel. D'autre part, nous traitons cette question, sous l'angle informel.Méthodes – Pour aborder cette question formellement, nous testons la présence de chaos dans des ventes de biens à la mode avec deux méthodes : une estimation, robuste au bruit, de l'exposant maximum de Lyapunov et la dimension de corrélation. Puis, nous évaluons l'horizon de prévisibilité de ces ventes pour savoir dans quelle mesure les membres de l'organisation, chargés du budget, peuvent contrôler ces ventes présentant une « complexité restreinte » au sens de Morin. Pour traiter de cette question de manière informelle, une étude de cas a été réalisée pour montrer qu'il est possible de contrôler des systèmes complexes, présentant un fort couplage au sens de Perrow, en utilisant les solutions mises en avant par la théorie des organisations hautement fiables.Résultats – Que l'on aborde la question des liens entre contrôlabilité et complexité sous l'angle formel ou informel, il apparaît que les membres d'une organisation peuvent contrôler des situations de gestion complexes, de façon décentralisée, dans la mesure où ils possèdent une marge de manœuvre
Objective – This PhD thesis aims at showing to what extent the members of an organization can control complex management situations. This research question was addressed by adopting two perspectives. We mathematically considered the link between complexity and controllability in the one hand. On the other, weddressed this issue by adopting organizational perspectives.Methods – To address mathematically this matter, the presence of chaos was tested, in some sales of fashion goods, by two methods: an estimation of Lyapunov exponent which is robust to noise and correlation dimension. Then, predictability horizon was estimated in order to know to what extent the members of an organization who set the budget can control these “complex” sales, in Morin's restricted sense. In order to informally deal with this issue, a case study was realized to show that it is possible for the members of an organization to control complex and tight coupled systems, in Perrow's sense, by using the guidelines of the High Reliability Theory.Results – Whatever perspective we take, it appears that the members of an organization can control complex management situations in a decentralized way to the extent that they have a certain amount of latitude

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Pereira, Ana Cristina. « Uma contribui????o ? ? an??lise dos m??todos de custeio aplicados ??s atividades hospitalares ». FECAP - Faculdade Escola de Com??rcio ??lvares Penteado, 2002. http://132.0.0.61:8080/tede/handle/tede/631.

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The opening and stabilization of the economy has caused fierce competition to arise between companies, which, therefore, are faced with the problem of how to manage to survive. Naturally, health institutions are also part of this reality. A company's survival guarantee is dependent upon the good results it shows. A company's results are directly related to a whole set of decisions made by the management. The decision-making process comprehends the phases of planning, execution and control. Adequate cost control can lead to the achievement of the previously agreed planning, thus allowing the good results which are necessary for the company's survival to be attained. Thus, this thesis is intended for contributing to an analysis of Cost Accounting, limiting the study to the methods of costing and their applicability to health institutions. The thesis presents a panorama of the health systems, the fundamentals of Cost Accounting and the characterization of these concepts in a health institution. An example of the application of the methodologies of costing by absorption, costing based in activities and variable costing, on which a reflection has been made, is given. The thesis, however, is not meant to be fully comprehensive and finished, allowing further contributions from other researchers to be made.
A abertura e a estabiliza????o da economia tem provocado entre as empresas uma competi????o acirrada, assim estas se v??em as voltas com o problema de garantir a sua sobreviv??ncia. Naturalmente nesta realidade tamb??m est??o inseridas as institui????es hospitalares. A garantia de sobreviv??ncia de uma empresa est?? atrelada aos resultados positivos que esta alcan??a. Os resultados de uma empresa est??o diretamente relacionados a um conjunto de decis??es tomadas pelos gestores. O processo de tomada de decis??es abrange as etapas de planejamento, execu????o e controle. O controle adequado de custos pode conduzir ?? consecu????o adequada do planejamento previamente estabelecido, obtendo-se assim os resultados positivos necess??rios ?? sobreviv??ncia da empresa. Assim este trabalho pretende contribuir para uma an??lise da Contabilidade de Custos, delimitando o estudo aos m??todos de custeio e sua aplicabilidade nas institui????es hospitalares. O trabalho apresenta um panorama geral dos sistemas de sa??de, os fundamentos da Contabilidade de Custos e a caracteriza????o destes conceitos em uma institui????o hospitalar. ?? apresentado um exemplo da aplica????o das metodologias de custeio por absor????o, custeio baseado em atividades e custeio vari??vel e sobre as quais realizou-se uma reflex??o. Entretanto o trabalho n??o ?? exaustivo, pronto e acabado podendo receber novas contribui????es de outros pesquisadores.

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Coelho, Jair Jo??o dos Santos. « Um estudo sobre a utiliza????o do sistema de custeio baseado em atividades (ABC) em uma unidade de di??lise ». FECAP - Faculdade Escola de Com??rcio ??lvares Penteado, 2003. http://132.0.0.61:8080/tede/handle/tede/632.

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To research means to gather knowledge. Such knowledge may arise from various sources; sources such as readings, case studies, fact investigations, document analysis, phenomena observations and any other sort of knowledge gathering activities. However, to gather knowledge is not enough. Spreading and sharing knowledge is what counts. Having in mind this concept and also having noticed the lack of literature concerning the use of cost-based systems inside medical institutions, we present here a research on the practice of a conceptual model of activity-based costs inside a Dialysis Unit, whose cost-object is the hemodyalitical session. We also verify the use and acceptance rates by the involved professionals of the aforementioned system by means of a case study followed by interviews. The ABC System has been chosen due to the belief that it is one of the best cost systems available, especially inside a health;-service environment, due to the fact that it aims to track the spending of resources by activities which are, in turn, themselves consumed by products and services. Firstly, the project presents a panorama of the Brazilian hospital system, describing the scenario in which of the country Dialysis Units are inserted. It also analyzes medical aspects related to dialysis such as chronic renal insufficiency and the dialytical processes, both very relevant and important themes in Nephrology. Secondly, we analyze the relevant aspects of the process of choosing a cost system as well as the advantages and disadvantages of each available system. Finally, we perform a case study, which follows a conceptual model, and then evaluate the use and acceptance rates of the cost system by means of various interviews with professionals involved in Nephrology. The research has indicated that the involved in Nephrology professionals find that the ABC System seems adequate for the Dialysis Unit because it allows for a more accurate analysis of the activities and tasks comprised under a dialytical session, which is the ultimate cost-object of this study.
Pesquisar compreende buscar conhecimento sob as mais diversas formas, como: leituras, estudo de caso, investiga????o de fatos, an??lises de documentos, observa????es de fen??menos dentre v??rias outras formas. Entretanto, buscar conhecimento n??o basta, ?? preciso divulg??-lo, partilh??-lo. Com base nesta vis??o e tendo evidenciado a escassez de literatura existente sobre a utiliza????o de sistemas de custos nas institui????es hospitalares, esta pesquisa objetiva oferecer sua contribui????o, apresentando a aplica????o de um modelo conceitual de custeio baseado em atividades em uma Unidade de Di??lise, cujo objeto de custo ?? a sess??o de hemodi??lise, bem como verificar a utiliza????o e aceita????o do referido sistema mediante um estudo de caso seguido de entrevistas. Foi escolhido o Sistema ABC em decorr??ncia deste m??todo estar sendo apontado como uma das melhores metodologias de custeio, principalmente na ??rea de sa??de, na medida em que busca rastrear os recursos consumidos pelas atividades que s??o consumidas pelos produtos ou servi??os. Inicialmente este trabalho apresenta um panorama do sistema hospitalar brasileiro, descreve o cen??rio das unidades de di??lise no pa??s, abordando aspectos da medicina ligados ?? di??lise como, a insufici??ncia renal cr??nica e os processos dial??ticos, temas estes de fundamental import??ncia na ??rea de nefrologia. Em seguida ?? feita uma an??lise sobre os aspectos relevantes na escolha do sistema de custos, observando as vantagens e desvantagens de cada sistema. Finalmente, aplica-se o estudo de caso que segue um modelo conceitual, e mediante entrevistas com profissionais da ??rea de nefrologia apura-se tanto a utiliza????o quanto a aceita????o deste sistema. A pesquisa revela que o m??todo ABC, para os profissionais da ??rea de nefrologia, ?? adequado para a Unidade de Di??lise por permitir uma an??lise mais apurada nas atividades e tarefas impl??citas na sess??o de hemodi??lise (objeto de custo deste estudo).

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