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- O orçamento da União Europeia - A problemática da sua insuficiênciaPublication . Curado, HenriqueO debate proposto - o orçamento da União Europeia vs a problemática da sua insuficiência - resulta da comparação das seguintes grandezas: o crescimento necessário para que a União Europeia se assumisse mais solidária , mais friendly dos problemas regionais e as perspectivas financeiras assumidas até 1999.
- Bacteriófagos no tratamento de feridasPublication . Flores, Joana; Baylina, Pilar; Balcão, Victor; Justiniano, Aníbal; Gibbs, PaulAs infecções bacterianas, particularmente as causadas por bactérias resistentes aos antibióticos, permanecem a principal causa de morte entre pacientes hospitalizados com queimaduras e feridas. Para além da terapêutica sistémica, um elemento-chave na gestão de feridas infectadas é a aplicação local de antimicrobianos eficazes. Os bacteriófagos (ou fagos) têm demonstrado um elevado potencial de cura no tratamento de feridas infectadas com estirpes bacterianas resistentes aos antibióticos.
- Os sistemas de inteligência num contexto de Homeland Defence e a tutela da privacidadePublication . Curado, Henrique; Gomes, Paulo VelosoA Estratégia para a Segurança Nacional, ao constituir um pilar estruturante da soberania de um estado de direito, deve ser reflectida sobre uma perpspectiva multidimensional na qual a actuação dos diferentes actuantes é determinante.
- Gestão de informação pessoal em saúdePublication . Amorim, Humberta; Caetano, João Carlos; Curado, HenriqueO sistema de gestão de proteção de dados pessoais e estudos clínicos em Portugal levanta controvérsia e uma interpretação distinta, dada a sensibilidade ética do tema, a integridade humana. Além deste fato, estamos diante de um problema que envolve diversos interesses e, assim, um confronto de posições. Pretende-se, ao longo deste artigo, abordar a percepção da forma como os profissionais da área da saúde, no seu quotidiano, lidam com a questão do tratamento de dados clínicos, numa tentativa de harmonizar pontos de vista e de conteúdo, verificando se há realmente um esforço das instituições hospitalares para facilitarem este processo e permitirem que os usuários sejam universalmente protegidos e bem tratados. Os resultados obtidos no documento de consulta de profissionais de saúde indicam que há uma preocupação com a confidencialidade em 100% dos inquiridos, embora existam sistemas de gestão de dados clínicos diferenciados (seis distintos). Espera-se uma tendência ascendente na procura dessas informações úteis e de interesse para deter essa informação, tomada por profissionais de saúde, instituições de saúde, seguradoras etc. O problema surge no confronto entre a proteção da vida privada, o interesse específico de usuários, o interesse público e as políticas institucionais e governamentais vigentes. Partindo do pressuposto de que a garantia de confidencialidade é uma realidade em termos de segurança, é necessário determinar se os meios utilizados para atingir essa tarefa são os mais eficientes e permitem uma gestão sustentável dos dados de saúde.
- Os sistemas de inteligência num contexto de Homeland Defence e a tutela da privacidadePublication . Curado, Henrique; Gomes, Paulo Sérgio Machado VelosoA utilização crescente das Tecnologias da Comunicação e Informação (TIC) como ferramenta privilegiada dos sistemas de inteleigência (instrumentos de salvaguarda da defesa e segurança nacional) pressupondo o tratamento de dados pessoais, veio trazer à colação a indispensabilidade de uma reflexão sobre tais operações face à necessária protecção da privacidade.
- Healthcare-associated infections – on developing effective control systems under a renewed healthcare management debatePublication . Baylina, Pilar; Moreira, PauloThe development of control systems to sustain the level of healthcare-associated infections (HAIs) is an emerging issue for healthcare management. This is partly due to the perception that HAI became a serious negative impact factor on the performance of healthcare organizations and on related public health dimensions. Throughout the decade of 1990 a significant number of international programmes were developed to understand and to promote effective HAIs prevention and control systems: Patient Safety and the quality improvement of healthcare organizations became common concepts in healthcare management. However, regardless of advances in infection control systems, the rates of incidence of HAIs remained relatively unchanged in the last decades. The purpose of this study is to point out barriers that recent international literature has identified as factors hindering the successful development of control systems to prevent HAIs. The international debate on possible alternatives to strengthen this common healthcare management issue, benefits form one such update. A literature review was conducted in a 3-month period by two investigators. The BioMed Central, Pubmed, Emerald, and B-on databases were searched for articles published between January 2006 and September 2011. A standard form was created for data extraction. A total of 49 articles met inclusion criteria. Within the analysed articles, 26 were developed in Europe, 15 were developed in North America; 6 were developed in Asia, and 2 in Australia. Thirty (30) different barriers to effective HAIs control systems were identified. The barriers were clustered by dimensions and sub-dimensions. The largest number of barriers clustered, are associated with structures and processes and also barriers associated with healthcare management processes.
- Challenging healthcare-associated infections: a review of healthcare quality management issuesPublication . Baylina, Pilar; Moreira, PauloHealthcare-associated infections (HAIs) are now a worldwide problem with devastating effects, both in economic and public health impacts in the medium and long term. In reality, this healthcare management problem became frightening when we became aware of large number of cases associated with this type of infection, especially the infections caused by agents for which the existing treatment no longer works effectively. This is the case of infections associated with healthcare caused by multi-resistant microorganisms, whose line of action in therapeutic terms may be exhausted. Several factors of growth have been identified, among which are the overuse of antibiotics (by direct intake or through food), environmental conditions, and the evolution of microorganisms. This means that, all over the world, rates of high prevalence and incidence for diseases caused by HAIs agents are now new contributions to rates of mortality and morbidity. Yet, already in 1959 a report on hospital infections by Staphylococcus, published by the Central Health Services UK, identified the prevalence of Staphylococcus as a major concern. Since then, this type of infection continued to occur, in spite of a growing understanding of the necessary measures for their control. It is known that, currently, the percentage of methicillin-resistant Staphylococcus aureus (MRSA) existing in the bacterial population of S. aureus associated with HAIs varies between 1% (Netherlands and Finland) and 44% (UK and Greece). However, regardless of advances in infection control systems, the incidence of HAIs remained relatively unchanged in the last 20 years (about 10%). The situation does not get better when we analyse the problem from the cost perspective. At this point, it is known that there is a direct impact in the hospitalization costs, in diagnostics (tests, examinations, etc.), and in treatments (antibiotics, surgery, and others). A 1992 CDC study estimated costs of HAIs and already suggested that the cost of infection control programs was approximately 6% of the total costs of the infections. In a 2003 report by the United Kingdom (UK) Department of Health, entitled ‘Winning Ways: Working together to Reduce HAIs in England’, it was estimated that the cost associated with HAIs per patient bed for a year was identical to the cost of an infection control program applied to a hospital with 250 beds. On what concerns quality management system, costs with HAIs may be comprised as non-quality costs. In this sense, an estimate by the Juran Institutes, suggests that non-quality costs can be approximately one-third of direct healthcare costs, and according to Nordgren et al. inflation of related costs is, in part, due to the increased length of stay and associated increased costs with providing the extra implicit care. This article explores these issues.
- Management system certification benefits: where do we stand?Publication . Fonseca, Luís; Domingues, José Pedro; Baylina, Pilar; Calderón, MarioPurpose: The implementation and certification of Management Systems International Standards, such as ISO 9001 and ISO 14001, achieved a high international recognition, with more than 1 million organizations with their Quality Management Systems certified worldwide. Researchers have been paying considerable attention to this theme and the number of published articles has robustly grown. Although on an overall basis, the research results support the existence of positive impacts on the adoption and certification of these International Standards, there are various inconsistencies and contradictory results, leading to some controversy over its impacts for organizations. This study aims to bring a longitudinal time perspective to this area of research, analyzing the articles published since 1996, on the benefits of Management Systems Certification. A longitudinal perspective of countries of authors origin, keywords and journals is presented, complemented with an evaluation of the research results. Design/methodology/approach: A Bibliometric Study supported the research, with data collected from Web of Science, SCOPUS, and Research Gate data bases. Following the detailed analysis of the journal titles, articles abstracts and their full content, an evaluation scale was adopted to assess if the results support the existence of a positive relationship between Management System Certification and economic, financial or stakeholder results. Findings: The results evidence a steep increase in the number of publications addressing Management Systems Certification benefits, that mainly originate from Europe (48%) and East Asia and Pacific (23%), with Spain as the leading country (accounting for 14% of the total number of articles published between 1996 and April 2017). Journal of Cleaner Production (Environmental Management System Certification) and Total Quality Management and Business Excellence journal (Quality Management Systems Certification) are the leading journals for disseminating the research and the most used keywords are “Quality/Environment”, “ISO 9001/14001”, “Performance”, “Management Systems” and “Certification”. There are also insights that the research is now open to other Management Systems either than Quality and Environment. The systematic review of the selected papers shows that the Management Systems adoption and certification brings fairly positive benefits (average 2,34 in a 1 to 5 Likert type scale) for the certified organizations, although some variations are observed. Some avenues for future research should consider the reliability and validation of measures; sampling and biases errors; the identification of control, moderating and mediating variables; the consideration of time and situational contingencies; and the search for explanations for cause and effect relationships. The results of this research support the view that the investigation of Management Systems Certification benefits is indeed an issue of high academic and practitioners interest. This research, although subject to some subjective evaluation of the authors, and acknowledging that the research articles are not always comparable, aims to give some insights for this continuous research field. Research limitations/implications: Although the authors took measures to minimize subjectivity, it should be noted that the evaluation could be subject to the authors own interpretation and the research articles are not always comparable. Originality/value: This research presents a longitudinal and comprehensive evaluation of the articles published since 1996 addressing the topics of the benefits of Management System Certification. It highlights trends and gives contribution for future research, on a field of intense academic and practitioners interest.
- Exploring the real costs of healthcare-associated infections: an international reviewPublication . Moura, João; Baylina, Pilar; Moreira, PauloHealthcare-associated infections acquired a high degree of dissemination, being considered a serious public health problem and assumed as one of the most common adverse events associated with healthcare. They have a significant impact on health systems by increasing hospital expenses, and compromising the healthcare quality and effectiveness. Surgical site infections (SSI) are considered one of the most serious complications that can occur after an orthopaedic surgery. The aim of this study is to contribute to the development of a framework to analyse the costs of infections related to hip and knee arthroplasties. A literature review was conducted on databases, and articles published between January 2005 and April 2016 were searched. A total of 14 articles met the inclusion criteria. Costs were grouped in hospitalization and treatment dimensions. For hospitalization, the indicators were the length of stay (LOS) and/or monetary costs; For treatment, the indicators were number of surgeries and LOS, or monetary costs. We observed that LOS is the most commonly used to estimate SSI direct costs. Patients who developed hip or knee arthroplasty infections remained in hospital 2.5–3 times longer and incurred hospital costs almost three times higher, when compared with an uninfected patient.
- Development and validation of a health and work survey based on the rasch model among portuguese WorkersPublication . Barros, Carla; Cunha, Liliana; Baylina, Pilar; Oliveira, Alexandra; Rocha, ÁlvaroThe purpose of this study was to develop the Health and Work Survey (INSAT) and examine the validity of the discomfort rating scale. Data were collected from 706 Portuguese workers from six economic sectors with the support of the Health and Work Survey (INSAT - Inquérito Saúde e Trabalho). The INSAT is a self-administered questionnaire to assessing working conditions, health and wellbeing, and to provide information to the occupational health systems in the organisations. For the survey instrument validation, the Rasch Partial Credit Model (PCM) was used to analyse item fit statistics. From the application of PCM, Person Separation Reliability was obtained (0.8761) and the value can be considered very good (>0.8). From the statistical analysis, the Overall Model fit information, given by Outfit Mean square/Infit Mean square, is between 0.5 and 1.5, meaning "Productive for measurement" and "acceptable fit overall". The INSAT items can generate predictable response patterns. We recommend that the INSAT discomfort rating scale and some other items should be reviewed in future works. In any event, this tool proves to be useful in assessing the relationship between work and health and in evaluating key main risk factors, helping to prevent problems and improving occupational health systems.