Customization in prescribing for bipolar disorder.

Science.gov (United States)

Hodgkin, Dominic; Volpe-Vartanian, Joanna; Merrick, Elizabeth L; Horgan, Constance M; Nierenberg, Andrew A; Frank, Richard G; Lee, Sue

2012-06-01

For many disorders, patient heterogeneity requires physicians to customize their treatment to each patient's needs. We test for the existence of customization in physicians' prescribing for bipolar disorder, using data from a naturalistic clinical effectiveness trial of bipolar disorder treatment (STEP-BD), which did not constrain physician prescribing. Multinomial logit is used to model the physician's choice among five combinations of drug classes. We find that our observed measure of the patient's clinical status played only a limited role in the choice among drug class combinations, even for conditions such as mania that are expected to affect class choice. However, treatment of a patient with given characteristics differed widely depending on which physician was seen. The explanatory power of the model was low. There was variation within each physician's prescribing, but the results do not suggest a high degree of customization in physicians' prescribing, based on our measure of clinical status. Copyright © 2011 John Wiley & Sons, Ltd.

Hackers e sua relação com o surgimento e desenvolvimento da chipmusic

Directory of Open Access Journals (Sweden)

Camila Schäfer

2015-07-01

Full Text Available O presente artigo tem como objetivo relacionar as características da microcultura hacker com o surgimento e desenvolvimento da cena musical chipmusic. Para isso, utilizam-se dados divulgados amplamente sobre a cena chipmusic internacional, além de entrevistas com um grupo de músicos brasileiros. Por fim, conclui-se que, tanto a microcultura hacker, como o desenvolvimento da tecnocultura atual, têm criado nas pessoas um desejo de explorar os limites de hardwares e softwares, que, por sua vez, acaba dando origem a cenas como a chipmusic, objeto deste trabalho. 

DIREITOS HUMANOS, DESENVOLVIMENTO SUSTENTÁVEL E SUSTENTABILIDADE

OpenAIRE

Carvalho, Sonia Aparecida de; Silva, Denival Francisco da; Adolfo, Luiz Gonzaga Silva

2015-01-01

Este artigo trata da relação intrínseca entre os direitos humanos, o desenvolvimento sustentável e a sustentabilidade. Seu objetivo geral consiste em analisar o modelo de desenvolvimento implementado e a necessária proteção e preservação do meio ambiente ligado à defesa dos direitos humanos. Os objetivos específicos pretendem investigar a distinção dos termos sustentabilidade e desenvolvimento sustentável, como a concretização do direito à sustentabilidade, os critérios e as dimensões da sust...

Automation bias in electronic prescribing.

Science.gov (United States)

Lyell, David; Magrabi, Farah; Raban, Magdalena Z; Pont, L G; Baysari, Melissa T; Day, Richard O; Coiera, Enrico

2017-03-16

Clinical decision support (CDS) in e-prescribing can improve safety by alerting potential errors, but introduces new sources of risk. Automation bias (AB) occurs when users over-rely on CDS, reducing vigilance in information seeking and processing. Evidence of AB has been found in other clinical tasks, but has not yet been tested with e-prescribing. This study tests for the presence of AB in e-prescribing and the impact of task complexity and interruptions on AB. One hundred and twenty students in the final two years of a medical degree prescribed medicines for nine clinical scenarios using a simulated e-prescribing system. Quality of CDS (correct, incorrect and no CDS) and task complexity (low, low + interruption and high) were varied between conditions. Omission errors (failure to detect prescribing errors) and commission errors (acceptance of false positive alerts) were measured. Compared to scenarios with no CDS, correct CDS reduced omission errors by 38.3% (p < .0001, n = 120), 46.6% (p < .0001, n = 70), and 39.2% (p < .0001, n = 120) for low, low + interrupt and high complexity scenarios respectively. Incorrect CDS increased omission errors by 33.3% (p < .0001, n = 120), 24.5% (p < .009, n = 82), and 26.7% (p < .0001, n = 120). Participants made commission errors, 65.8% (p < .0001, n = 120), 53.5% (p < .0001, n = 82), and 51.7% (p < .0001, n = 120). Task complexity and interruptions had no impact on AB. This study found evidence of AB omission and commission errors in e-prescribing. Verification of CDS alerts is key to avoiding AB errors. However, interventions focused on this have had limited success to date. Clinicians should remain vigilant to the risks of CDS failures and verify CDS.

Inappropriate prescribing in the elderly.

LENUS (Irish Health Repository)

Gallagher, P

2012-02-03

BACKGROUND AND OBJECTIVE: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. METHODS: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. RESULTS AND DISCUSSION: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. CONCLUSION: Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug

Gestões do desenvolvimento e desenvolvimentos da gestão: da unilateralidade reificada à dialogicidade da simbiose homem/natureza

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Carlos Eduardo Justen

Full Text Available Este artigo, ao situar culturalmente os fenômenos da gestão e do desenvolvimento, em sua concepção tradicional, no projeto da modernidade e ao identificar o predomínio da unilateralidade reificada na interface entre gestão e desenvolvimento - a primeira vista como instrumento técnico submisso à via clássica do segundo - almeja evidenciar as potencialidades da compreensão e da construção de alternativas, tanto para a gestão como para o desenvolvimento, a partir da ressignificação dessa interface. Para tanto, o esforço foi direcionado ao resgate do que é comum aos fenômenos da gestão e do desenvolvimento - os substratos antropológico e ecológico -, nucleados nos princípios da reciprocidade dialógica, concretizadora da condição antropológica, e da finitude, caracterizadora da condição ecológica. Ao final, são apresentadas oito potenciais contribuições advindas da exploração renovada da interface entre a gestão e o desenvolvimento. Propôs-se, ainda, a substituição da lógica instrumental da eficiência financeira, comum à concepção tradicional dos fenômenos estudados, pela lógica da simbiose dialógica homem/natureza, uma vez que, como fenômenos sociais, desenvolvimento e gestão, mediados pelo meio, também são ecológicos em sua essência.

Control of invasive weeds with prescribed burning

Science.gov (United States)

DiTomaso, Joseph M.; Brooks, Matthew L.; Allen, Edith B.; Minnich, Ralph; Rice, Peter M.; Kyser, Guy B.

2006-01-01

Prescribed burning has primarily been used as a tool for the control of invasive late-season annual broadleaf and grass species, particularly yellow starthistle, medusahead, barb goatgrass, and several bromes. However, timely burning of a few invasive biennial broadleaves (e.g., sweetclover and garlic mustard), perennial grasses (e.g., bluegrasses and smooth brome), and woody species (e.g., brooms and Chinese tallow tree) also has been successful. In many cases, the effectiveness of prescribed burning can be enhanced when incorporated into an integrated vegetation management program. Although there are some excellent examples of successful use of prescribed burning for the control of invasive species, a limited number of species have been evaluated. In addition, few studies have measured the impact of prescribed burning on the long-term changes in plant communities, impacts to endangered plant species, effects on wildlife and insect populations, and alterations in soil biology, including nutrition, mycorrhizae, and hydrology. In this review, we evaluate the current state of knowledge on prescribed burning as a tool for invasive weed management.

Social determinants of prescribed and non-prescribed medicine use

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García-Altés Anna

2010-05-01

Full Text Available Abstract Background The aim of the present study was to describe the use of prescribed and non prescribed medicines in a non-institutionalised population older than 15 years of an urban area during the year 2000, in terms of age and gender, social class, employment status and type of Primary Health Care. Methods Cross-sectional study. Information came from the 2000 Barcelona Health Interview Survey. The indicators used were the prevalence of use of prescribed and non-prescribed medicines in the two weeks prior to the interview. Descriptive analyses, bivariate and multivariate logistic regression analyses were carried out. Results More women than men took medicines (75.8% vs. 60% respectively. The prevalence of use of prescribed medicines increased with age while the prevalence of non-prescribed use decreased. These age differences are smaller among those with poor perceived health. In terms of social class, a higher percentage of men with good health in the more advantaged classes took non-prescribed medicines compared with disadvantaged classes (38.7% vs 31.8%. In contrast, among the group with poor health, more people from the more advantaged classes took prescribed medicines, compared with disadvantaged classes (51.4% vs 33.3%. A higher proportion of people who were either retired, unemployed or students, with good health, used prescribed medicines. Conclusion This study shows that beside health needs, there are social determinants affecting medicine consumption in the city of Barcelona.

O desafio político do desenvolvimento sustentado

OpenAIRE

Guimarães,Roberto P.

1995-01-01

A unanimidade que hoje parece haver em favor do desenvolvimento sustentado contrasta com a ausência de iniciativas políticas significativas para transformar as instituições econômicas, sociais e políticas que estão comprometidas com o estilo vigente de desenvolvimento. Em particular, há uma patente contradição entre o discurso antiestatista hegemônico e as exigências do desenvolvimento sustentado, que incluem um Estado ainda mais forte, em suas capacidades reguladoras e de planificação, que o...

Nutrição e desenvolvimento Nutrition and development

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Ilma K. G. de Arruda

1994-09-01

Full Text Available As discussões sobre desenvolvimento e nutrição freqüentemente se realizam sob um duplo enfoque: aqueles que consideram o estado nutricional como reflexo do desenvolvimento, e os que admitem que a nutrição influencia fortemente no nível e ritmo desse desenvolvimento. Os autores focalizam o tema visualizando a nutrição como um fator decisivo para um bom desenvolvimento social e econômico, particularizando o fato de que as intervenções nutricionais podem contribuir para melhorias significativas nos resultados escolares, na produtividade do trabalho e na resistência às infecções. Assim, os reflexos da desnutrição na economia seriam evidentes: quer pelas limitações na expectativa de renda, quer pelo aumento dos custos dos compromissos que a população assume para proteger-se, quer pelos avultados custos ocultos de origem social - absenteísmo, acidentes do trabalho e rotatividade de pessoal. Em face dos propósitos de modernização e competitividade da economia, é inquestionável a necessidade da nutrição figurar bem alto na lista de prioridades nacionais. Com isso, promover-se-ia o desenvolvimento dos recursos humanos e a preservação desse capital, que é o ideário de uma economia socialmente responsável.Discussions on development and nutrition frequently have a double focus: one that considers nutritional status as a reflection of development, and another that admits that nutrition strongly influences the level and rhythm of development. The authors view nutrition as a decisive factor for adequate social and economic development, specifying the fact that nutritional interventions might contribute to significant improvements in individual classroom performance, productivity at the workplace, and resistance to infections. The implications of malnutrition for the economy are thus evident: either by limitations in income expectations, increased costs deriving from burdens assumed by the population to protect themselves, or

CONHECIMENTO: UM FATOR DE DESENVOLVIMENTO ORGANIZACIONAL

Directory of Open Access Journals (Sweden)

Adilson dos Santos Morais

2017-09-01

Full Text Available Cada vez mais, criar conhecimento útil para atuar em uma posição de vantagem competitiva, orientado para o desenvolvimento organizacional e valorizando o capital humano tem-se demonstrato uma estratégia eficaz. O presente artigo busca apresentar a importância do conhecimento para o desenvolvimento das organizações em âmbito geral com destaque para as comunidades de prática. Esse conhecimento é derivado das interações desenvolvidas em processos de aprendizagem que ocorrem no ambiente organizacional. Para este, realizou-se um estudo teórico, descritivo, que tem como procedimento a pesquisa bibliográfica. Deste modo, apresenta como resultado deste trabalho a evidência de que existem poucos resultados divulgados sobre retorno financeiro e os benefícios dos investimentos realizados no capital intelectual humano pelas organizações. Porém, o conhecimento agrega valor à organização aumentando o valor do capital intelectual e as literaturas sobre o conhecimento e desenvolvimento organizacional consideram o capital intelectual o fator chave para a melhoria nos sistemas estratégicos. Destaca-se que esta contribuição poderá instigar cada vez mais a criação de conhecimento como fator de reconhecimento humano e de desenvolvimento das organizações.

e-Learning initiatives to support prescribing

Science.gov (United States)

Maxwell, Simon; Mucklow, John

2012-01-01

Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. PMID:22509885

Desenvolvimento e sociologia: uma aproximação necessária

Directory of Open Access Journals (Sweden)

Alessandro André Leme

2015-08-01

Full Text Available ResumoO debate acerca do desenvolvimento na América Latina e no Brasil em particular revelou-se como um dos temas proeminentes do pensamento sociopolítico e econômico brasileiro. As interpretações do Brasil a partir da temática do desenvolvimento ganham força a partir da década de 1930, porém, será após a Segunda Guerra Mundial, com a intensificação da industrialização e a modernização da sociedade capitalista brasileira, que o tema adquire centralidade na sociologia/ciência política. Por outro lado, as discussões acerca do Estado e do desenvolvimento estão intimamente ligadas ao desenvolvimento do capitalismo brasileiro, ou seja, configura uma tríade que simultaneamente evidencia tanto um tipo historicamente determinado de Estado como um tipo particular de desenvolvimento econômico e social do país. O desenvolvimento do Brasil caracteriza-se por um embate entre o mercado e o Estado, sendo a influência desse último fundante para o padrão de desenvolvimento pretendido no país. Propomos a análise do processo de desenvolvimento como forma de revisitar o debate teórico e conceitual produzido sobre a temática no país, assim como investigar o movimento histórico, econômico e político adotado pelo Brasil como estratégia para o desenvolvimento nos anos 1990.

Evaluation of a diabetes nurse specialist prescribing project.

Science.gov (United States)

Wilkinson, Jill; Carryer, Jenny; Adams, Jeffery

2014-08-01

To evaluate the diabetes nurse specialist prescribing project with the aim of determining whether diabetes nurse specialist prescribing is safe and effective and to inform the implementation and extension of registered nurse prescribing. Registered nurses in many countries are able to prescribe medicines, but in New Zealand, prior to the diabetes nurse specialist project, nurse practitioners were the only nurses who could prescribe medicines. New regulations allowed the nurses to prescribe a limited number of prescription medicines. The study was a process and outcome clinical programme evaluation. The project took place between April-September 2011 and involved 12 diabetes nurse specialist in four localities. Quantitative data were collected from clinical records maintained by the diabetes nurse specialist for the project (1274 patients and 3402 prescribing events), from surveys with stakeholders (general practitioners, n = 30; team members, n = 19; and patients, n = 89) and audits from patient notes (n = 117) and prescriptions (n = 227), and qualitative data from interviews with project participants (n = 18) and patients (n = 19). All data were analysed descriptively. Diabetes nurse specialist prescribing was determined to be safe, of high quality and appropriate. It brought important benefits to the effectiveness of specialist diabetes services, was acceptable to patients and was supported by the wider healthcare team. These findings are consistent with the findings reported in the international literature about nurse prescribing in a range of different practice areas. Clarification of the education and competence requirements and resourcing for the ongoing supervision of nurses is recommended if the prescribing model is to be extended. Diabetes nurse specialist prescribing improved access to medicines by providing a more timely service. Nurses felt more satisfied with their work because they could independently provide a complete episode of care

Air Pollution Episodes Associated with Prescribed Burns

Science.gov (United States)

Hart, M.; Di Virgilio, G.; Jiang, N.

2017-12-01

Air pollution events associated with wildfires have been associated with extreme health impacts. Prescribed burns are an important tool to reduce the severity of wildfires. However, if undertaken during unfavourable meteorological conditions, they too have the capacity to trigger extreme air pollution events. The Australian state of New South Wales has increased the annual average area treated by prescribed burn activities by 45%, in order to limit wildfire activity. Prescribed burns need to be undertaken during meteorological conditions that allow the fuel load to burn, while still allowing the burn to remain under control. These conditions are similar to those that inhibit atmospheric dispersion, resulting in a fine balance between managing fire risk and managing ambient air pollution. During prescribed burns, the Sydney air shed can experience elevated particulate matter concentrations, especially fine particulates (PM2.5) that occasionally exceed national air quality standards. Using pollutant and meteorological data from sixteen monitoring stations in Sydney we used generalized additive model and CART analyses to profile the meteorological conditions influencing air quality during planned burns. The insights gained from this study will help improve prescribed burn scheduling in order to reduce the pollution risk to the community, while allowing fire agencies to conduct this important work.

e-Learning initiatives to support prescribing.

Science.gov (United States)

Maxwell, Simon; Mucklow, John

2012-10-01

Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

CERVEJA ARTESANAL E DESENVOLVIMENTO REGIONAL EM SANTA CATARINA (BRASIL)

OpenAIRE

Valdinho Pellin; Oklinger Mantovaneli Jr.

2016-01-01

Discussões relacionadas ao fortalecimento do desenvolvimento regional tem estimulado um debate em relação a contribuições que Indicações Geográficas (IGs) podem oferecer ao desenvolvimento. IGs se constituem em elemento de identificação de produtos ou serviços com seus territórios e podem oferecer contribuições importantes para o desenvolvimento regional, agregando valor aos produtos, facilitando o acesso a novos mercados e valorizando tradições locais. Este artigo procura discutir a importân...

Bens culturais acessíveis às crianças: limites e possibilidades para o desenvolvimento cultural na educação infantil

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Muriane Sirlene Silva de Assis

2012-10-01

Full Text Available Este trabalho é parte de uma tese de doutorado que investigou o processo de desenvolvimento cultural da criança na Educação Infantil a partir das concepções de diferentes sujeitos. O presente trabalho focalizou as concepções das crianças, das professoras e dos pais sobre o acesso das crianças aos bens culturais. A pesquisa utilizou procedimentos metodológicos fundamentados em abordagem qualitativa e coletou dados por meio de entrevistas semiestruturadas e questionários. A Teoria Histórico-Cultural serviu de fundamentação teórica para o estudo. A análise dos dados enunciou que a escola e a família contribuíam para o desenvolvimento cultural das crianças, todavia, essa contribuição ocorria de forma pouco intencional e sistematizada. A pesquisa demonstrou que o acesso das crianças e dos adultos aos bens culturais era restrito e limitado, em especial à televisão, e isso empobrecia as possibilidades de desenvolvimento cultural deles. As atividades artísticas e culturais eram interpretadas como recurso didático-pedagógico e raramente se vinculavam ao lazer, ao divertimento, a ampliação da visão de mundo e consequentemente ao desenvolvimento cultural. O estudo ressaltou que não basta ter acesso aos bens culturais, há que se buscar por meio da apropriação do patrimônio cultural da humanidade, uma atuação mais consciente na prática social.

Rede de Protagonismo Local para o Desenvolvimento Global

DEFF Research Database (Denmark)

Weber, Ángela; Hermann, Roberto Rivas

Este artigo pretende fazer uma reflexão sobre metodologia a ser desenvolvida e utilizada num projeto de desenvolvimento local, através das ações protagonizadas pela própria comunidade. Para isso parte de uma discussão sobre o conceito de desenvolvimento sustentável, e a seguir propõe a busca de f...

Da revolução verde ao discurso do PRONAF: a representação do desenvolvimento nas políticas públicas de desenvolvimento rural no Brasil

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Michell Leonard Duarte de Lima Tolentino

2016-12-01

Full Text Available Este trabalho procura refletir acerca das várias representações de desenvolvimento que embasam algumas das políticas públicas de desenvolvimento rural no Brasil, partindo das representações de desenvolvimento subjacentes à Revolução Verde e focando, posteriormente, no discurso do Programa Nacional de Fortalecimento da Agricultura Familiar (PRONAF. O trabalho se embasa em uma ampla pesquisa bibliográfica e documental. De início abordamos o discurso do desenvolvimento de forma crítica, para logo depois atentarmos para a maneira como este coloca o espaço rural. Para tanto utilizamos autores como Esteva (2000, Escobar (2000, Santos (1979 e Montenegro Gómez (2006. Posteriormente analisamos a Revolução Verde “brasileira” compreendendo o fordismo enquanto seu principal modelo de desenvolvimento. Em seguida, partimos para uma reflexão mais profunda sobre o PRONAF. O PRONAF assume fundamental importância nesse trabalho, pois o entendemos enquanto uma política de extrema relevância para se ler esse momento de inflexão das políticas públicas para o campo, de mudança nas representações sobre o espaço rural e o desenvolvimento rural brasileiro. Ao nos determos no PRONAF, discutimos a mudança de um modelo de desenvolvimento fordista para um modelo de desenvolvimento flexível.

PROPOSTA TEÓRICO-CONCEITUAL DE DESENVOLVIMENTO EM ARRANJOS PRODUTIVOS LOCAIS

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Adriana Valélia Saraceni

2013-04-01

Full Text Available O objetivo central deste trabalho foi evidenciar algumas ferramentas para o desenvolvimento da inovação e verificar a relação com a configuração do desenvolvimento em Arranjos Produtivos Locais (APLs. Esta pesquisa pode ser considerada como exploratória e descritiva, pois envolve levantamento bibliográfico e análise de exemplos que estimulem a compreensão. Estudos sobre ferramentas de inovação tecnológica e referencias do desenvolvimento de ecossistemas industriais, foram utilizados buscando demonstrar uma proposta teórico-conceitual de integração das ferramentas. Por meio do resultado obtido com a aplicação da metodologia e do referencial teórico, verificou-se que aplicação das ferramentas de inovação tecnológica e a operacionalização com a implantação de métodos e ações cooperadas, tende a fortalecer o desempenho do processo de inovação do arranjo produtivo. A aplicação do conceito de ecologia industrial no desenvolvimento ambientalmente sustentável do aglomerado tende a fortalecer não só o desenvolvimento do APL, como também o desenvolvimento econômico e regional.

Pharmaceutical marketing research and the prescribing physician.

Science.gov (United States)

Greene, Jeremy A

2007-05-15

Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue.

Prescribing Behavior of General Practitioners : Competition Matters!

NARCIS (Netherlands)

Schaumans, C.B.C.

2014-01-01

Background: General Practitioners have limited means to compete. As quality is hard to observe by patients, GPs have incentives to signal quality by using instruments patients perceive as quality. Objectives: We investigate whether GPs exhibit different prescribing behavior (volume and value of

O desenvolvimento sustentável: uma palavra e as coisas

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Wolf-Dietrich SAHR

1998-12-01

Full Text Available A discussão sobre o desenvolvimento sustentável é um exercício interessante para se entender as novas formas do relacionamento entre a ciência e a política que surgiram durante os trinta anos passados. Originalmente vindo do âmbito da economia e modificado por abordagens ecológicas, o conceito se transformou, durante os anos 80, em palavra-chave nas discussões internacionais e interdisciplinares sobre o desenvolvimento em sua relação com a natureza. Percebe-se que várias qualidades clássicas da metodologia científica, como exatidão das definições e termos técnicos, epistemologias disciplinares e rígidas formulações de teorias, perderam gradativamente sua relevância durante esse processo. Isso colocou os limites da própria ciência acadêmica em questão. Através de uma crítica do economicismo ecológico, que até hoje domina no discurso, abre-se um espaço para a incorporação de abordagens epistemológicas diferentes da ciência pura como atividades sociais, métodos psico-analíticos e até mesmo atividades da arte e da religião. O discurso do desenvolvimento sustentável apresenta-se, deste modo, como uma modificação cultural do próprio meio académico nas condições da pós-modernidade.

The Value of Electronically Extracted Data for Auditing Outpatient Antimicrobial Prescribing.

Science.gov (United States)

Livorsi, Daniel J; Linn, Carrie M; Alexander, Bruce; Heintz, Brett H; Tubbs, Traviss A; Perencevich, Eli N

2018-01-01

OBJECTIVE The optimal approach to auditing outpatient antimicrobial prescribing has not been established. We assessed how different types of electronic data-including prescriptions, patient-visits, and International Classification of Disease, Tenth Revision (ICD-10) codes-could inform automated antimicrobial audits. DESIGN Outpatient visits during 2016 were retrospectively reviewed, including chart abstraction, if an antimicrobial was prescribed (cohort 1) or if the visit was associated with an infection-related ICD-10 code (cohort 2). Findings from cohorts 1 and 2 were compared. SETTING Primary care clinics and the emergency department (ED) at the Iowa City Veterans Affairs Medical Center. RESULTS In cohort 1, we reviewed 2,353 antimicrobial prescriptions across 52 providers. ICD-10 codes had limited sensitivity and positive predictive value (PPV) for validated cases of cystitis and pneumonia (sensitivity, 65.8%, 56.3%, respectively; PPV, 74.4%, 52.5%, respectively). The volume-adjusted antimicrobial prescribing rate was 13.6 per 100 ED visits and 7.5 per 100 primary care visits. In cohort 2, antimicrobials were not indicated in 474 of 851 visits (55.7%). The antimicrobial overtreatment rate was 48.8% for the ED and 59.7% for primary care. At the level of the individual prescriber, there was a positive correlation between a provider's volume-adjusted antimicrobial prescribing rate and the individualized rates of overtreatment in both the ED (r=0.72; P<.01) and the primary care setting (r=0.82; P=0.03). CONCLUSIONS In this single-center study, ICD-10 codes had limited sensitivity and PPV for 2 infections that typically require antimicrobials. Electronically extracted data on a provider's rate of volume-adjusted antimicrobial prescribing correlated with the frequency at which unnecessary antimicrobials were prescribed, but this may have been driven by outlier prescribers. Infect Control Hosp Epidemiol 2018;39:64-70.

Self: um conceito em desenvolvimento

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Lídia Suzana Rocha de Macedo

2012-08-01

Full Text Available Diversas definições de self coexistem nas teorias e práticas psicológicas. Essa variedade é resultante de bases epistemológicas a partir das quais se adotam estratégias diferentes para abordar e demarcar os limites do objeto em questão e descrevê-lo. Este estudo teve como objetivo oferecer uma revisão dos conceitos de self e uma reflexão sobre como esse conceito se articula nas diferentes abordagens teóricas da psicologia. Destaca-se que dilemas centrais à psicologia do desenvolvimento atravessam o conceito de self. Por essa razão, apresenta-se a tese de que, ao analisar cada definição de self, deve-se buscar responder como cada teoria colocou-se diante das dicotomias estabilidade versus transformação, específico versus universal e mundo interno versus mundo externo.

Rationalising prescribing

DEFF Research Database (Denmark)

Wadmann, Sarah; Bang, Lia Evi

2015-01-01

Initiatives in the name of 'rational pharmacotherapy' have been launched to alter what is seen as 'inappropriate' prescribing practices of physicians. Based on observations and interviews with 20 general practitioners (GPs) in 2009-2011, we explored how attempts to rationalise prescribing interac...

Prescribing behavior of general practitioners : Competition matters!

NARCIS (Netherlands)

Schaumans, C.B.C.

Background General Practitioners (GP) have limited means to compete. As quality is hard to observe by patients, GPs have incentives to signal quality by using instruments patients perceive as quality. Objectives I investigate whether GPs prescribe more units when confronted with more competition. As

Para onde nos guia a mão invisível? Considerações sobre os paradoxos do modelo econômico hegemônico e sobre os limites ecológicos do desenvolvimento

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Carolina Lopes Araujo

2014-08-01

Full Text Available A dinâmica do crescimento econômico contínuo vigente no capitalismo financeiro tem se mostrado incompatível com os limites planetários. A humanidade se encontra em um impasse ético, econômico e tecnológico. O modelo de produção e consumo vigente se mostra insuficiente para assegurar condições de vida digna para toda a humanidade no presente e aponta para uma deterioração dessas condições em um futuro próximo. Este artigo realiza uma revisão bibliográfica de trabalhos clássicos na teoria do desenvolvimento sustentável e, por meio da abordagem crítica da economia capitalista, coloca em xeque o conceito hegemônico do progresso e aponta a insuficiência do paradigma do crescimento para assegurar o desenvolvimento sustentável. Mesclando e conjugando as ideias dos principais autores dessas áreas, o artigo conclui que a sustentabilidade do desenvolvimento requer condicionantes que, ao longo do tempo, se tornam mais difíceis de serem alcançados. A dinâmica atual do sistema econômico leva a desgastes ambientais com efeitos cada vez mais severos, que serão sentidos especialmente a partir de 2030, podendo chegar a um colapso antes de 2100, comprometendo a capacidade de sobrevivência humana no planeta. A sustentabilidade, a suficiência e a equidade do desenvolvimento exigem uma mudança estrutural no paradigma de produção e de consumo. Para tanto, se fazem necessários mecanismos sociais, institucionais e informacionais, além da adequação e da coordenação dos avanços tecnológicos.

CHANGING PRESCRIBING CULTURE - A FOCUS ON CODEINE POSTPARTUM.

Science.gov (United States)

Al-Adhami, Noor; Whitfield, Karen; North, Angela

2016-09-01

To eliminate the prescribing of codeine and codeine combination products postpartum to improve safety in breast fed infants.Concerns have been raised over the use of codeine and codeine combination products during breast feeding after the death of a neonate whose mother had been prescribed codeine postpartum. High concentrations of morphine were found in the infant's blood and this was attributed to the mother being a CYP2D6 ultrafast metaboliser.1 METHODS: The evidence surrounding the safety of codeine and codeine combination products in children, during the postpartum period and specifically for breast fed infants was collated. The evidence was presented to key stakeholders including obstetricians, midwives, safety and quality representatives, nurse unit managers and acute pain team representatives. Postpartum analgesia was discussed and an agreed protocol developed. Training and education sessions were undertaken to obstetric medical and nursing staff. The evidence that was presented to key stakeholders included:▸ Reports over the safety concerns surrounding the use of codeine and codeine combination products during breast feeding▸ Guidelines and contraindications about the use of codeine in children that had been issued by international regulatory bodies (US Food and Drug Administration and European Medicines Agency).▸ Recommendations from the Australian Medicines Handbook to avoid in breast feeding2 ▸ Recommendations from Hale's Medications and Mothers Milk that reported limited data and had made a recent re-classification from L3 (limited data-probably compatible) to L4 (limited data-possibly hazardous).3 Before presenting the evidence to key stakeholders and undertaking training to nursing and medical staff, more than 90% of postpartum women were prescribed a codeine containing product as part of their 'as required' analgesic regimen.Since the intervention, codeine combination products have now been almost completely eliminated on medication

Modeling of outpatient prescribing process in iran: a gateway toward electronic prescribing system.

Science.gov (United States)

Ahmadi, Maryam; Samadbeik, Mahnaz; Sadoughi, Farahnaz

2014-01-01

Implementation of electronic prescribing system can overcome many problems of the paper prescribing system, and provide numerous opportunities of more effective and advantageous prescribing. Successful implementation of such a system requires complete and deep understanding of work content, human force, and workflow of paper prescribing. The current study was designed in order to model the current business process of outpatient prescribing in Iran and clarify different actions during this process. In order to describe the prescribing process and the system features in Iran, the methodology of business process modeling and analysis was used in the present study. The results of the process documentation were analyzed using a conceptual model of workflow elements and the technique of modeling "As-Is" business processes. Analysis of the current (as-is) prescribing process demonstrated that Iran stood at the first levels of sophistication in graduated levels of electronic prescribing, namely electronic prescription reference, and that there were problematic areas including bottlenecks, redundant and duplicated work, concentration of decision nodes, and communicative weaknesses among stakeholders of the process. Using information technology in some activities of medication prescription in Iran has not eliminated the dependence of the stakeholders on paper-based documents and prescriptions. Therefore, it is necessary to implement proper system programming in order to support change management and solve the problems in the existing prescribing process. To this end, a suitable basis should be provided for reorganization and improvement of the prescribing process for the future electronic systems.

Repensando a relação entre Estado, direito e desenvolvimento: os limites do paradigma rule of law e a relevância das alternativas institucionais Rethinking the relation between state, law and development

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Mario Gomes Schapiro

2010-06-01

Full Text Available Assumindo a primazia da abordagem institucionalista na agenda contemporânea do desenvolvimento, este artigo procurará discutir alguns de seus limites, descritivos e normativos, no que tange, em especial, ao sistema financeiro. particularmente, procurar-se-á sugerir que os programas de difusão do rule of law têm se constituído em um paradigma estreito do papel exercido pelo direito, segundo a qual cabe ao ambiente jurídico cumprir, apenas e tão somente, a função de garantidor dos interesses de investidores privados, entendidos como atores centrais de um modelo de financiamento baseado em transações de mercado. o texto sugere que o paradigma rule of law, como estratégia de promoção do desenvolvimento, tem dificuldade em lidar com a existência de alternativas institucionais de organização econômica e financeira, para além de um modelo de mercado baseado em atores atomizados e carentes de segurança jurídica. um exemplo disso, que escapa do instrumental tradicional, é o modelo brasileiro de financiamento, que, apesar de ter vivenciado inúmeras reformas institucionais, dedicadas a elevar o nível de proteção de investidores, ainda concentra em um banco de desenvolvimento - o BNDES - grande parte do financiamento de longo prazo do país. o artigo assume, portanto, que, sim, o direito e as instituições, de fato, importam para o desenvolvimento, mas há uma variedade de possibilidades e funções a serem exercidas pelos arranjos institucionais e ferramentas jurídicas - muito além do que supõem os programas de Rule of Law. uma bem sucedida organização institucional baseada em um banco de desenvolvimento é um exemplo disso.Taken the prevalence of institutionalist and Rule of Law approach in the contemporary debate on economic development, this paper intends to discuss some theoretical limits of this literature, either positive or normative, mainly in its application to discussions related to the financial sector. this

Herbicides as an alternative to prescribed burning for achieving wildlife management objectives

Science.gov (United States)

T. Bently Wigley; Karl V. Miller; David S. deCalesta; Mark W. Thomas

2002-01-01

Prescribed burning is used for many silvicultural and wildlife management objectives. However, the use of prescribed burning can be constrained due to difficulties in obtaining burning permits, concerns about liability, potential effects of scorch on growth and survival of crop trees, its sometimes ineffective results, limited burning days, and the costs of applying,...

O conceito histórico de desenvolvimento econômico

OpenAIRE

Pereira, Luiz C. Bresser

2006-01-01

Uma Análise do Conceito de Desenvolvimento Econômico. o Crescimento Econômico, ou Desenvolvimento Econômico, é Visto como um Fenômeno Histórico como Resultado da Revolução Capitalista, E, Consequentemente, da Revolução Comercial, da Industrial E, no Meio Delas, da Revolução Nacional. Assim, é Necessário um Conceito Histórico de Crescimento Econômico, e não um Conceito Normativo. Visto sob este Aspecto, o Desenvolvimento Econômico é Intrinsecamente Relacionado ao Surgimento do Estado-Nação M...

Determinantes do desenvolvimento do setor agropecuário nos municípios

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Caio César de Medeiros Costa

2013-06-01

Full Text Available Dada a importância do setor agropecuário para a economia brasileira, é fundamental conhecer os fatores determinantes do desenvolvimento agropecuário em seus municípios. Sob a luz de referencial teórico que aborda questões relacionadas aos fatores determinantes do desenvolvimento agropecuário e do desenvolvimento econômico local, neste estudo fez-se uso das metodologias de análise multivariada conhecidas como análise fatorial e análise de cluster. Utilizou-se o estado de Minas Gerais como recorte analítico. Foram selecionadas 22 variáveis para cada município, representando diferentes dimensões do desenvolvimento, visando verificar quais os fatores determinantes do desenvolvimento agropecuário. Após a análise fatorial, optou-se pela extração de seis fatores com raiz característica maior do que um e que respondem, em conjunto, por 62,25% da variância total dos dados: desenvolvimento econômico, investimento público, qualidade de vida, condições da atividade agropecuária, condições de meio ambiente e consumo, e condições de financiamento. Pela análise de cluster, foram criados cinco grupos, de acordo com o desempenho dos membros nos fatores. Os resultados corroboram os apontamentos literários em quase sua totalidade e, além disso, destaca-se e discute-se a existência de um ciclo positivo gerado pelo incremento dos fatores determinantes do desenvolvimento agropecuário e pelas vantagens competitivas. Neste estudo, aponta-se a importância do investimento público na promoção do desenvolvimento, reforçando o proposto por trabalhos anteriores de que o Estado desempenha papel fundamental para garantir condições que propiciem o desenvolvimento do setor agropecuário. Outra constatação factível é a de que fatores isolados, tais como as boas condições da agricultura e do meio ambiente, não são capazes de propiciar desenvolvimento para o setor nos municípios mineiros.

Learning from prescribing errors

OpenAIRE

Dean, B

2002-01-01



 The importance of learning from medical error has recently received increasing emphasis. This paper focuses on prescribing errors and argues that, while learning from prescribing errors is a laudable goal, there are currently barriers that can prevent this occurring. Learning from errors can take place on an individual level, at a team level, and across an organisation. Barriers to learning from prescribing errors include the non-discovery of many prescribing errors, lack of feedback to th...

A família e a escola como contextos de desenvolvimento humano

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Maria Auxiliadora Dessen

2007-04-01

Full Text Available Escola e família constituem dois contextos de desenvolvimento fundamentais para a trajetória de vida das pessoas. Neste artigo, são destacadas as contribuições destes contextos para a promoção do desenvolvimento humano, enfatizando suas implicações nos processos evolutivos. Questões sobre configurações, vínculos familiares e a importância da rede social de apoio para o desenvolvimento da família são discutidas. Focalizam-se as funções da escola, considerando sua influência nas pessoas em desenvolvimento. Apontam-se algumas considerações sobre a necessidade de compreender as inter-relações entre escola e família, visando facilitar a aprendizagem e desenvolvimento humano. A integração entre esses dois contextos é destacada como desafio para a prática profissional e pesquisa empírica.

Valores e Desenvolvimento Humano

NARCIS (Netherlands)

F. Comim (Flavio); A. Macedo de Jesus (Anderson); R.C.B Oliveira (Raissa); A. Davison (Anna); S. Galeno (Sabrina); A.C.V. Ribeiro (Ana)

2010-01-01

markdownabstractA primeira parte desse Relatório de Desenvolvimento Humano do Brasil 2009/2010 começa com a descrição de um amplo processo de consulta aberta à sociedade, denominada Brasil Ponto a Ponto, para a escolha do tema do relatório. A Campanha Brasil Ponto a Ponto teve por objetivo

Coordination through databases can improve prescribed burning as a conservation tool to promote forest biodiversity.

Science.gov (United States)

Ramberg, Ellinor; Strengbom, Joachim; Granath, Gustaf

2018-04-01

Prescribed fires are a common nature conservation practice. They are executed by several parties with limited coordination among them, and little consideration for wildfire occurrences and habitat requirements of fire-dependent species. Here, we gathered data on prescribed fires and wildfires in Sweden during 2011-2015 to (i) evaluate the importance and spatial extent of prescribed fires compared to wildfires and (ii) illustrate how a database can be used as a management tool for prescribed fires. We found that on average only 0.006% (prescribed 65%, wildfires 35%) of the Swedish forest burns per year, with 58% of the prescribed fires occurring on clearcuts. Also, both wildfires and prescribed fires seem to be important for the survival of fire-dependent species. A national fire database would simplify coordination and make planning and evaluation of prescribed fires more efficient. We propose an adaptive management strategy to improve the outcome of prescribed fires.

Preparando um ambiente de desenvolvimento para a plataforma android

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Felipe Pires de Oliveira

2015-11-01

Full Text Available Este artigo descreve as etapas para a criação de um ambiente de desenvolvimento para a plataforma Android. O artigo foi dividido em quatro partes: Primeiro uma introdução sobre o assunto. Na segunda seção são mostrados os passos necessários para a configuração do ambiente de desenvolvimento. Na terceira seção, é demonstrado como criar uma aplicação para dispositivo Android que calculo Índice de Massa Corporal (IMC. A quarta seção apresenta as considerações finais. A solução abordada tem como base a IDE Eclipse e o SDK do Android, bem como o Kit de Desenvolvimento Java da Oracle (JDK.

Preparando um ambiente de desenvolvimento para a plataforma android

Directory of Open Access Journals (Sweden)

Felipe Pires de Oliveira

2015-12-01

Full Text Available Este artigo descreve as etapas para a criação de um ambiente de desenvolvimento para a plataforma Android. O artigo foi dividido em quatro partes: Primeiro uma introdução sobre o assunto. Na segunda seção são mostrados os passos necessários para a configuração do ambiente de desenvolvimento. Na terceira seção, é demonstrado como criar uma aplicação para dispositivo Android que calculo Índice de Massa Corporal (IMC. A quarta seção apresenta as considerações finais. A solução abordada tem como base a IDE Eclipse e o SDK do Android, bem como o Kit de Desenvolvimento Java da Oracle (JDK.

Amenidades ambientais e desenvolvimento rural

OpenAIRE

Dentinho, Tomaz; Rodrigues, Orlando

2007-01-01

Este texto sobre amenidades ambientais e desenvolvimento rural trata, fundamentalmente, da incerteza resultante da reacção das pessoas e das instituições face aos recursos naturais que exploram e quanto ao efeito das políticas que são implementadas.

Determinants of the range of drugs prescribed in general practice: a cross-sectional analysis.

NARCIS (Netherlands)

Bakker, D.H. de; Coffie, D.S.V.; Heerdink, E.R.; Dijk, L. van; Groenewegen, P.P.

2007-01-01

BACKGROUND: Current health policies assume that prescribing is more efficient and rational when general practitioners (GPs) work with a formulary or restricted drugs lists and thus with a limited range of drugs. Therefore we studied determinants of the range of drugs prescribed by general

PATRIMÔNIO CULTURAL ARQUEOLÓGICO: INSTRUMENTO DE DESENVOLVIMENTO TURÍSTICO

OpenAIRE

Rossano Bastos

2012-01-01

O presente trabalho trata das perspectivas de aproveitamento do Patrimônio Cultural Arqueológico como instrumento de desenvolvimento turístico.PALAVRAS-CHAVE: Arqueologia; Turismo;Desenvolvimento.ABSTRACT: This work considers some improvement perspectives ofthe archaeological cultural heritage as an instrument of tourism development.KEY-WORDS: Archaeology; Tourism; Development. 

Teoria da reciprocidade e sócio-antropologiado desenvolvimento Theory of reciprocity and social anthropology of development

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Eric Sabourin

2011-08-01

Full Text Available No momento em que o ensino da sociologia do desenvolvimento está declinando nas universidades européias e, em menor grau, nas latino-americanas, afirma-se uma renovação da teoria da reciprocidade, precisamente nesse campo e no da economia social, a partir da antropologia e da sociologia econômica. O artigo trata, portanto, da contribuição da teoria da reciprocidade para a sócioantropologia do desenvolvimento. Divide-se em duas partes. A primeira apresenta brevemente os precursores e os fundamentos da teoria da reciprocidade. A segunda ilustra, a partir de alguns exemplos contemporâneos, a aplicação dessa teoria à sócio-antropologia do desenvolvimento rural. As considerações finais tratam dos limites e novas perspectivas heurísticas dessa teoria.At a time when the teaching of sociology of development is fading from European universities, and to a lesser extent in Latin America, appears a renewal of the theory of reciprocity in this field of social economy, coming from anthropology and sociological economics. The article presents the contribution of the theory of reciprocity to a socio-anthropology of development. It is divided into two parts. The first briefly presents the forerunners and foundations of the theory of reciprocity. The second illustrates, from some contemporary examples, applying this theory to socio-anthropology of rural development. The conclusion presents the limits and some new heuristic perspectives of this theory.

Prescribing Privileges for Psychologists: A Public Service or Hazard?

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Shaheen E. Lakhan

2007-07-01

Full Text Available The privilege to prescribe pharmacotherapeutics has been granted in limited areas to psychologists. The psychologist's role in society may be approaching a great evolution that can dramatically impact the state of mental healthcare and the discipline of psychiatry. Opponents argue drug company funding and cheaper non-PhD psychological professionals fuel the movement for prescription rights for PhD level psychologists. However, proponents claim that this right would equip psychologists with greater psychotherapeutic modalities and the capability of having richer doctor-patient relationships to diagnose and treat underserved populations. Nonetheless, the paucity of prescribing psychologist studies cannot allow the biopsychosocial community to make firm opinions, let alone a decision on this debate. This article reviews the history of clinical psychology and highlights the potential divergence into collaborative clinical and health psychologists and autonomous prescribing psychologists.

Robust test limits

NARCIS (Netherlands)

Albers, Willem/Wim; Kallenberg, W.C.M.; Otten, G.D.

1997-01-01

Because of inaccuracies of the measurement process inspection of manufactured parts requires test limits which are more strict than the given specification limits. Test limits derived under the assumption of normality for product characteristics turn out to violate the prescribed bound on the

Os eventos programados, como alternativo do desenvolvimento do turismo

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Andrés Pinassi

2014-10-01

Full Text Available Turismo e lazer são vistos como uma alternativa para o desenvolvimento econômico, social e cultural de uma comunidade. Ambas práticas de lazer são consolidadas como processos sócio-espaciais que podem trazer muitos impactos benéficos para os moradores de uma determinada localidade. Assim, a dinâmica de eventos programados em aldeias visa proporcionar uma alternativa oportunidades de desenvolvimento local para comunidades carentes. Nesse contexto, a pesquisa desenvolvida, em seguida, analisa o desenvolvimento de um festival especial, realizada na Provincia de Buenos Aires (Argentina. Este festival, iniciado a partir da esfera pública municipal, mostrou benefícios económicos significativos e definir um entretenimento alternativa valiosa para a população local e da área de influência.

Desenvolvimento e Gestão Pública: das ideias às práticas

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Jackeline Amantino de Andrade

2010-11-01

Full Text Available Este artigo tem como objetivo tratar dos modelos de desenvolvimento no contexto brasileiro e introduzir uma discussão sobre políticas de desenvolvimento e sua gestão. Para tanto, faz-se necessário resgatar a discussão sobre desenvolvimento tanto em suas bases desenvolvimentistas como a atual proposição de desenvolvimento endógeno. Entende-se que o desenvolvimento depende de uma capacidade organizacional na articulação de vários fatores, tangíveis e intangíveis, quantitativos e qualitativos e envolve várias dimensões: econômica, social, cultural, ambiental e físico-territorial, político-institucional e científico-tecnológica e é construído através de estratégias processuais potencializadas por coletivos. A primeira parte apresenta uma discussão conceitual sobre o desenvolvimento e os processos de organizacionais e de gestão neles implicados. A segunda parte apresenta um estudo empírico de caráter exploratório de modo a ampliar a discussão sobre modelos de desenvolvimento a partir da relação entre teoria e prática. Finalmente, são tecidas algumas considerações sobre o por vir, principalmente, quando se considera que nesses tempos de globalização e de acirramento das desigualdades urge encontrar alternativas justas e solidárias para as sociedades.

Evaluation of a multifaceted intervention to limit excessive antipsychotic co-prescribing in schizophrenia out-patients

DEFF Research Database (Denmark)

Baandrup, Lone; Allerup, Peter; Lublin, H

2010-01-01

polypharmacy, socioeconomic status and functional level of patients. The intervention was aimed at psychiatric healthcare providers and consisted of 1 day of didactic lectures, six 3-h educational outreach visits and an electronic reminder during drug prescribing. RESULTS: Between-group use of antipsychotic...

Perspectives on Trends, Effectiveness, and Impediments to Prescribed Burning in the Southern U.S.

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Leda N. Kobziar

2015-02-01

Full Text Available The southern region of the U.S. uses prescribed fire as a management tool on more of its burnable land than anywhere in the U.S., with ecosystem restoration, wildlife habitat enhancement, and reduction of hazardous fuel loads as typical goals. Although the region performs more than 50,000 prescribed fire treatments each year, evaluation of their effects on wildfire suppression resources or behavior/effects is limited. To better understand trends in the use and effectiveness of prescribed fire, we conducted a region-wide survey of 523 fire use practitioners, working on both public and private lands. A 1–2 year prescribed fire interval was consistently viewed as effective in decreasing wildfire ignitions, behavior, and severity, as well as reducing suppression resources needed where wildfire occurred. Yet fewer than 15% of practitioners viewed burn intervals of 3–4 years as effective in reducing ignitions, underscoring the importance of high-frequency burning in vegetation communities where fuel recovery is rapid. Public lands managers identified limited budget and staffing as major institutional impediments to prescribed fire, in contrast to private individuals, more of whom chose liability as a key challenge. Differences in responses across ownership type, state, and vegetation type call for a broader perspective on how fire managers in the southern U.S. view prescribed fire.

Desenvolvimento de um monitor de apneia pediátrico

OpenAIRE

Caldeira, Gonçalo José Martins

2009-01-01

O trabalho apresentado tem por base o desenvolvimento de um monitor de apneia do sono pediátrico. Aborda questões ao nível da fisiologia respiratória e da mecânica pulmonar de um indivíduo. Apresenta uma proposta de desenvolvimento de um monitor de aquisição e identificação de sinais respiratórios, a fim de efectuar a detecção da apneia do sono.

Desenvolvimento sustentável: um discurso sobre a relação entre desenvolvimento e natureza Sustainable development: a discourse about the relation between development and nature

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Hugo Juliano Duarte Matias

2008-04-01

Full Text Available Trata-se do estudo de definições de desenvolvimento sustentável, elemento fundamental de repertórios interpretativos para a relação entre desenvolvimento e natureza. As definições respondiam a um questionário aplicado a 355 estudantes de vários cursos de uma universidade federal. Realizou-se uma análise de conteúdo que buscou a concepção de natureza e sua relação com desenvolvimento nessas definições. Foram encontradas três matrizes discursivas: (a "economicista" - a necessidade de desenvolvimento subordina a necessidade de preservação da natureza, cujo sentido é "recursos naturais"; (b discurso "bem intencionado" - a necessidade de desenvolvimento subordina a de preservação da natureza, cujo sentido é "fragilidade"; (c "esvaziado" - desenvolvimento e natureza são disjuntos. Conclui-se sobre a importância do estudo da atribuição de significado à natureza para explicar como as pessoas pensam a relação entre desenvolvimento e natureza, e sobre como essas matrizes discursivas podem justificar práticas sociais.This study presents the analysis of definitions of sustainable development, as a basic element of interpretative repertoires for the relation between development and nature. Three hundred and fifty five students of several courses of a federal university answered a questionnaire, providing the definitions, thereafter submitted to content analysis to examine the concept of nature and its relation with development. Three discursive matrixes were found: (a the "economic bias" one - the necessity of development subordinates the need of nature preservation nature is a "natural resources"; (b the "good intentions" discourse - the necessity of development subordinates the necessity of preservation - nature is "fragility"; (c the "empty" - one development and nature are separate. It is concluded that the attribution of meaning to nature is important to explain how people think about the relation between development and

Inglês como língua franca: desenvolvimentos recentes

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Telma Gimenez

Full Text Available Em face da atual posição do inglês como uma língua franca global, este artigo tem como principal objetivo discutir os desenvolvimentos recentes dessa área, tomando como base os trabalhos apresentados durante a 7th International Conference on English as a Lingua Franca, realizada em Atenas, Grécia, em setembro de 2014. As reflexões, aprofundadas nos tópicos i Teorizações sobre ILF; ii ILF e formação de professores; iii Desenvolvimentos futuros, trazem um olhar analítico sobre os temas discutidos no evento. Espera-se que as informações e reflexões aqui contempladas possam contribuir para o desenvolvimento de uma "curiosidade acadêmica" a respeito do paradigma ILF (inglês como língua franca e para o engajamento com suas questões e implicações.

Electronic prescribing: criteria for evaluating handheld prescribing systems and an evaluation of a new, handheld, wireless wide area network (WWAN) prescribing system.

Science.gov (United States)

Goldblum, O M

2001-02-01

The objectives of this study were: 1) to establish criteria for evaluating handheld computerized prescribing systems; and 2) to evaluate out-of-box performance and features of a new, Palm Operating System (OS)-based, handheld, wireless wide area network (WWAN) prescribing system. The system consisted of a Palm Vx handheld organizer, a Novatel Minstrel V wireless modem, OmniSky wireless internet access and ePhysician ePad 1.1, the Palm OS electronic prescribing software program. A dermatologist familiar with healthcare information technology conducted an evaluation of the performance and features of a new, handheld, WWAN electronic prescribing system in an office practice during a three-month period in 2000. System performance, defined as transmission success rate, was determined from data collected during the three-month trial. Evaluation criteria consisted of an analysis of features found in electronic prescribing systems. All prescriptions written for all patients seen during a three-month period (August - November, 2000) were eligible for inclusion. Prescriptions written for patients who intended to fill them at pharmacies without known facsimile receiving capabilities were excluded from the study. The performance of the system was evaluated using data collected during the study. Criteria for evaluating features of electronic prescribing systems were developed and used to analyze the system employed in this study. During this three-month trial, 200 electronic prescriptions were generated for 132 patients included in the study. Of these prescriptions, 92.5 percent were successfully transmitted to pharmacies. Transmission failures resulted from incorrect facsimile numbers and non-functioning facsimile machines. Criteria established for evaluation of electronic prescribing systems included System (Hardware & Software), Costs, System Features, Printing & Transmission, Formulary & Insurance, Customization, Drug Safety and Security. This study is the first effort to

Inappropriate prescribing: criteria, detection and prevention.

LENUS (Irish Health Repository)

O'Connor, Marie N

2012-06-01

Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.

Tutorial para o Desenvolvimento de Jogos 2D usando a Linguagem Java

Directory of Open Access Journals (Sweden)

Soraia Teixeira Barbosa

2015-07-01

Full Text Available Atualmente é grande o estudo e desenvolvimento de jogos eletrônicos tanto no meio acadêmico como fora dele. Entretanto o desenvolvimento do mesmo não é uma tarefa trivial. Este artigo mostra o desenvolvimento de um jogo computacional através de uma versão do conhecido jogo de arcade Space Invaders. O artigo proposto tem como objetivo mostrar os passos básicos para a construção de um jogo computacional em duas dimensões utilizando a linguagem de programação Java.

DANÇA E O DESENVOLVIMENTO MOTOR DE PORTADORES DE NECESSIDADES EDUCATIVAS ESPECIAIS - PNEEs

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Liliane de Oliveira

2012-04-01

Full Text Available O estudo objetivou verificar as modificações nos padrões de desenvolvimento motor de PNEEs mediante prática da dança. Participaram 14 PNEEs do CIEP/Cruz Alta. O instrumento foi a Escala de Desenvolvimento Motor (Rosa Neto, 1996. Utilizou-se a estatística descritiva e teste “t” para análise dos dados. Observou-se diferenças estatisticamente significativas (p<0,05 entre pré e pós-testes nas variáveis idade cronológica, motora geral, motricidade ampla e equilíbrio. Concluiu-se que o programa de dança contribuiu significativamente para o desenvolvimento motor de PNEEs. Palavras chave: dança, motor, desenvolvimento, especial, educação.

Prescribed burning in the interior ponderosa pine type of northeastern California . . . a preliminary study

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Donald T. Gordon

1967-01-01

Three prescribed burns, made in 1959-62, in the interior ponderosa pine type of northeastern California are described in terms of meteorological factors, fire behavior, and effects of burning. Results were generally unsatisfactory. Factors that limit the usefulness of prescribed burning for reducing fuel hazard or for thinning in young-growth stands include stand...

Elaboração e avaliação de um website sobre o desenvolvimento da linguagem infantil: portal dos bebês - desenvolvimento da linguagem

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Aline Martins

2015-02-01

Full Text Available OBJETIVO: criar e desenvolver um website na área de fonoaudiologia com enfoque no desenvolvimento da linguagem de bebês de 0 a 48 meses, além de avaliar a qualidade do conteúdo apresentado e os recursos tecnológicos utilizados. MÉTODOS: na primeira fase do projeto foi realizado um levantamento de dados por meio de revisão de literatura sobre o desenvolvimento e aquisição da linguagem infantil. Em seguida esse conteúdo foi inserido no website e avaliado por 20 pais e/ou cuidadores. RESULTADO: o website Portal dos Bebês - Desenvolvimento da Linguagem foi desenvolvido com linguagem voltada a pais e/ou cuidadores, e seu conteúdo foi dividido em três temas: "Desenvolvimento da Linguagem", "Fala e Linguagem" e "Linguagem e o Ambiente". No que se refere à qualidade do conteúdo e da apresentação, o website foi avaliado como "excelente" por todos os participantes da amostra. Quanto à avaliação sobre o vocabulário utilizado e a forma de apresentação do conteúdo, 70% e 75% respectivamente, consideraram o website como "excelente". Em relação à apresentação visual, 85% dos participantes classificaram como "excelentes", já o tipo de navegação foi classificado como "satisfatório" por 50% dos participantes. Quanto à importância que os pais e/ou cuidadores julgam sobre o site a maioria classificou como "excelente" o auxilio que o mesmo dá no desenvolvimento da linguagem da criança. CONCLUSÃO: o website Portal dos Bebês - Desenvolvimento da Linguagem pode ser acessado pelo endereço online http://portaldosbebes.fob.usp.br, e seu conteúdo e recursos tecnológicos utilizados foram avaliados como satisfatório a excelente pelos pais e/ou cuidadores participantes.

The use of prescribed and non-prescribed medication by Dutch children.

NARCIS (Netherlands)

Dijk, L. van; Lindert, H. van

2002-01-01

Background: Most research on the use of medication focuses on adults. Children, however, use medication too, most of which is prescribed by GP's. Children also use non-prescribed medication (f.e. bought in the drugstore), but the extent to which is not known. Moreover, it is not known to what extent

A COMPLEXIDADE ECONÔMICA DOS DIREITOS HUMANOS: UMA DIMENSÃO ESCONDIDA DO DESENVOLVIMENTO HUMANO

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Leilane Serratine Grubba

2012-10-01

Full Text Available Este artigo tem por objeto a complexidade econômica dos direitos humanos, mais precisamente, a investigação da relação entre a complexidade econômica e o desenvolvimento humano. Nesse sentido, objetivou demonstrar a intrínseca relação e dependência do desenvolvimento humano à complexidade econômica dos direitos humanos, que influi na positivação dos direitos, assim como na luta pelo acesso aos bens necessários a uma vida digna. Por meio do método dedutivo, o artigo problematizou a relação entre o ser humano e seu contexto econômico-social para o desenvolvimento da vida em dignidade. Diante disso, em primeiro lugar, foi apresentada a noção de complexidade dos direitos humanos, isto é, as suas múltiplas dimensões. No segundo momento, foi analisada a questão econômica do desenvolvimento humano, ou seja, a relação entre o desenvolvimento da vida digna e a dimensão econômica da sociedade, e, finalmente, foi apresentada a complexidade econômica dos direitos humanos. O desenvolvimento humano não está apenas vinculado à dimensão econômica, mas compreende todas as dimensões (complexidade que perfazem uma vida digna de ser vivida. A vida se desenvolve em dignidade mediante o acesso aos bens materiais e imateriais. As políticas do desenvolvimento humano, nesse sentido, devem se integrar a uma estrutura que apoie um crescimento com equidade e sustentabilidade. Palavras-chave: Pensamento complexo. Complexidade econômica. Direitos humanos. Desenvolvimento humano. Dignidade humana.

The Supply of Prescription Opioids: Contributions of Episodic-Care Prescribers and High-Quantity Prescribers.

Science.gov (United States)

Schneberk, Todd; Raffetto, Brian; Kim, David; Schriger, David L

2018-06-01

We determine episodic and high-quantity prescribers' contribution to opioid prescriptions and total morphine milligram equivalents in California, especially among individuals prescribed large amounts of opioids. This was a cross-sectional descriptive analysis of opioid prescribing patterns during an 8-year period using the de-identified Controlled Substance Utilization Review and Evaluation System (CURES) database, the California subsection of the prescription drug monitoring program. We took a 10% random sample of all patients and stratified them by the amount of prescription opioids obtained during their maximal 90-day period. We identified "episodic prescribers" as those whose prescribing pattern included short-acting opioids on greater than 95% of all prescriptions, fewer than or equal to 31 pills on 95% of all prescriptions, only 1 prescription in the database for greater than 90% of all patients to whom they gave opioids, fewer than 6 prescriptions in the database to greater than 99% of patients given opioids, and fewer than 540 prescriptions per year. We identified top 5% prescribers by their morphine milligram equivalents per day in the database. We examined the relationship between patient opioid prescriptions and provider type, with the primary analysis performed on the patient cohort who received only short-acting opioids in an attempt to avoid guideline-concordant palliative, oncologic, and addiction care, and a secondary analysis performed on all patients. Among patients with short-acting opioid only, episodic prescribers (14.6% of 173,000 prescribers) wrote at least one prescription to 25% of 2.7 million individuals but were responsible for less than 9% of the 10.5 million opioid prescriptions and less than 3% of the 3.9 billion morphine milligram equivalents in our sample. Among individuals with high morphine milligram equivalents use, episodic prescribers were responsible for 2.8% of prescriptions and 0.6% of total morphine milligram equivalents

Effects of prescribed fires on soil properties: A review.

Science.gov (United States)

Alcañiz, M; Outeiro, L; Francos, M; Úbeda, X

2018-02-01

Soils constitute one of the most valuable resources on earth, especially because soil is renewable on human time scales. During the 20th century, a period marked by a widespread rural exodus and land abandonment, fire suppression policies were adopted facilitating the accumulation of fuel in forested areas, exacerbating the effects of wildfires, leading to severe degradation of soils. Prescribed fires emerged as an option for protecting forests and their soils from wildfires through the reduction of fuels levels. However such fires can serve other objectives, including stimulating the regeneration of a particular plant species, maintaining biological diversity or as a tool for recovering grasslands in encroached lands. This paper reviews studies examining the short- and long- term impacts of prescribed fires on the physical, chemical and biological soil properties; in so doing, it provides a summary of the benefits and drawbacks of this technique, to help determine if prescribed fires can be useful for managing the landscape. From the study conducted, we can affirm that prescribed fires affects soil properties but differ greatly depending on soil initial characteristics, vegetation or type of fire. Also, it is possible to see that soil's physical and biological properties are more strongly affected by prescribed fires than are its chemical properties. Finally, we conclude that prescribed fires clearly constitute a disturbance on the environment (positive, neutral or negative depending on the soil property studied), but most of the studies reviewed report a good recovery and their effects could be less pronounced than those of wildfires because of the limited soil heating and lower fire intensity and severity. Copyright © 2017. Published by Elsevier B.V.

Drug formularies--good or evil? A view using prescribing analyses and cost trends data.

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Chapman, S

1994-01-01

In the UK, the drugs bill has almost trebled in the last 10 years and is consuming an increasing proportion of the total National Health Service spend. If the drugs bill can be limited, greater funds will be available for other areas of the health service. Therefore, cost containment measures which include prescribing from a formulary or generic prescribing are now widely encouraged. Prescribing analyses and cost trends data generated from pharmacists sending dispensed general practitioners' prescriptions to a central point for reimbursement are a valuable tool in the assessment of prescribing habits and can be used by general practitioners when preparing a formulary. In the West Midlands, such data have been used to identify areas of growth in cardiovascular drugs and problem areas where prescribing an expensive formulation has led to a dramatic increase in costs.

Auditing GPs' prescribing habits : Cardiovascular prescribing frequently continues medication initiated by specialists

NARCIS (Netherlands)

de Vries, C.S; van Diepen, N.M; de Jong-van den Berg, L T W

Objective: To determine to what extent general practitioners' (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists. Method: During a 4-week period, pharmacists identified GPs' prescriptions for a large group of cardiovascular drugs.

Physician Prescribing Practices of Vitamin D in a Psychiatric Hospital.

Science.gov (United States)

Mulcahy, Kimberly B; Trigoboff, Eileen; Opler, Lewis; Demler, Tammie Lee

2016-01-01

Vitamin D supplementation has become an increasingly popular prescribing practice, despite our limited knowledge of both the definition and degree of deficiency as well as the expected benefits or risks of exogenous administration. Many of the hypothesized benefits of vitamin D supplementation include a variety of improvements in mental health; however, these claims are not consistently or robustly supported by current research. In this paper, we provide a brief overview of what is currently known about vitamin D deficiency and about outcomes of supplementation as well as a summary of the data relative to prescribing practices for inpatients in an urban psychiatric hospital.

The safety of meperidine prescribing in older adults: A longitudinal population-based study.

Science.gov (United States)

Friesen, Kevin J; Falk, Jamie; Bugden, Shawn

2016-05-11

Meperidine (pethidine) is an opioid analgesic that offers little advantage relative to other opioids and several disadvantages including limited potency, short duration of action, and the production of a neurotoxic metabolite (normeperidine) with a long half-life. Older adults are more sensitive to meperidine's side effects and may have diminished renal function which leads to the accumulation of normeperidine. The Institute for Safe Medication Practices has suggested avoiding meperidine in older adults, limiting its dose (≤600 mg/day) and duration of use (≤48 h). The objective of this study was to determine the level of meperidine use in older adults and assess the dosage and duration of meperidine with reference to these safety recommendations. A longitudinal study using administrative healthcare data was conducted to examine meperidine utilization and levels of high dose and extended duration prescribing among persons ≥65 years of age between April 1, 2001, and March 31, 2014 in Manitoba, Canada. The number of meperidine prescriptions, users, duration of treatment, defined daily doses (DDD) dispensed and number of prescribers were determined over the study period. In the Manitoba older adult population there was a marked decline in meperidine users and prescriptions from 2001 to 2014. There was an average use of 26.4 (95 % CI 24.0-28.8) DDDs of meperidine per user per year. While only 3.7 % of the prescriptions exceeded the 600 mg maximum daily dose, 96.7 % of prescriptions exceeded the recommended 2 days of therapy. For the remaining users of meperidine, the amount of meperidine used per person rose from 18.98 to 56.14 DDDs/user/year over the study period. The number of prescribers of meperidine declined throughout the study, but low DDD prescribers declined more quickly than high DDD prescribers. While meperidine use has declined, the remaining use appears to be decreasing in safety, with more meperidine prescribed per user. This seems to be driven by

Specialist pediatric palliative care prescribing practices: A large 5-year retrospective audit

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Anuja Damani

2016-01-01

Full Text Available Introduction: There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging specialty. Prescribing pain and symptom control drugs in children with cancer requires knowledge of palliative care formulary, dosing schedules, and prescription guidelines. This study is a retrospective audit of prescribing practices of a specialist palliative care service situated in a tertiary cancer center. Methods: A total of 1135 medication records of children receiving specialist pediatric palliative care services were audited for 5 years (2010-2014 to evaluate prescribing practices in children with advanced cancer. Results: A total of 51 types of drugs were prescribed with an average of 4.2 drugs per prescription. 66.9% of the prescriptions had paracetamol, and 33.9% of the prescriptions had morphine. Most common nonsteroidal anti-inflammatory drugs prescribed was ibuprofen (23.9%, and more than 50% of the prescriptions had aperients. The most commonly prescribed aperient was a combination of liquid paraffin and sodium-picosulfate. Dexamethasone was prescribed in 51.9% of patients and in most cases this was part of oral chemotherapy regimen. Generic names in prescription were used only in 33% of cases, and adverse effects of the drugs were documented in only 9% of cases. In 25% of cases, noncompliance to the WHO prescription guidelines was seen, and patient compliance to prescription was seen in 40% of cases. Conclusions: Audit of the prescribing practices in specialist pediatric palliative care service shows that knowledge of pediatric palliative care formulary, rational drug use, dosing, and prescribing guidelines is essential for symptom control in children with advanced life-limiting illness. Noncompliance to WHO prescribing guidelines in one fourth of cases and using nongeneric names in two-thirds of prescription indicates poor prescribing practices and warrants prescriber education. Prescription

Nurse prescribing for inpatient pain in the United Kingdom: a national questionnaire survey.

Science.gov (United States)

Stenner, Karen L; Courtenay, Molly; Cannons, Karin

2011-07-01

Nurses make a valuable contribution to pain services and have the potential to improve the safety and effectiveness of pain management. A recent addition to the role of the specialist pain nurse in the United Kingdom has been the introduction of prescribing rights, however there is a lack of literature about their role in prescribing pain medication. The aim of this study was to develop a profile of the experience, role and prescribing practice of these nurses. A descriptive questionnaire survey. 192 National Health Service public hospital inpatient pain services across the United Kingdom. 161 qualified nurse prescribers were invited to participate, representing 98% of known nurse prescribers contributing to inpatient pain services. The survey was completed in November 2009 by 137 nurses; a response rate of 85%. Compared with nurse prescribers in the United Kingdom in general, participants were highly qualified and experienced pain specialists. Fifty-six percent had qualified as a prescriber in the past 3 years and 22% reported that plans were underway for more nurses to undertake a nurse prescribing qualification. Although all participants worked in inpatient pain services, 35% also covered chronic pain (outpatient) services and 90% treated more than one pain type. A range of pain medications were prescribed, averaging 19.5 items per week. The role contained a strong educational component and contributed to informing organisational policy on pain management. Prescribing was said to improve nurses' ability to promote evidence-based practice but benefits were limited by legislation on prescribing controlled drugs. Findings demonstrate that pain nurses are increasingly adopting prescribing as part of their advanced nurse role. This has implications for the development needs of pain nurses in the United Kingdom and the future role development of nurses in other countries. Copyright © 2011 Elsevier Ltd. All rights reserved.

Prescribed fire research in Pennsylvania

Science.gov (United States)

Patrick Brose

2009-01-01

Prescribed fire in Pennsylvania is a relatively new forestry practice because of the State's adverse experience with highly destructive wildfires in the early 1900s. The recent introduction of prescribed fire raises a myriad of questions regarding its correct and safe use. This poster briefly describes the prescribed fire research projects of the Forestry Sciences...

Prescribing of methylphenidate to children and adolescents in South ...

African Journals Online (AJOL)

2008-11-13

Nov 13, 2008 ... Background: Pharmacoepidemiological studies on ADHD are limited in South Africa. The primary aim was to analyse the prescribing of methylphenidate to patients aged 18 years and younger in the private health care sector. Methods: Data for a one-month period in 2004 were obtained from a large ...

Prescribing of methylphenidate to children and adolescents in South ...

African Journals Online (AJOL)

Background: Pharmacoepidemiological studies on ADHD are limited in South Africa. The primary aim was to analyse the prescribing of methylphenidate to patients aged 18 years and younger in the private health care sector. Methods: Data for a one-month period in 2004 were obtained from a large medical aid ...

Prescriber and staff perceptions of an electronic prescribing system in primary care: a qualitative assessment

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Sittig Dean F

2010-11-01

Full Text Available Abstract Background The United States (US Health Information Technology for Economic and Clinical Health Act of 2009 has spurred adoption of electronic health records. The corresponding meaningful use criteria proposed by the Centers for Medicare and Medicaid Services mandates use of computerized provider order entry (CPOE systems. Yet, adoption in the US and other Western countries is low and descriptions of successful implementations are primarily from the inpatient setting; less frequently the ambulatory setting. We describe prescriber and staff perceptions of implementation of a CPOE system for medications (electronic- or e-prescribing system in the ambulatory setting. Methods Using a cross-sectional study design, we conducted eight focus groups at three primary care sites in an independent medical group. Each site represented a unique stage of e-prescribing implementation - pre/transition/post. We used a theoretically based, semi-structured questionnaire to elicit physician (n = 17 and staff (n = 53 perceptions of implementation of the e-prescribing system. We conducted a thematic analysis of focus group discussions using formal qualitative analytic techniques (i.e. deductive framework and grounded theory. Two coders independently coded to theoretical saturation and resolved discrepancies through discussions. Results Ten themes emerged that describe perceptions of e-prescribing implementation: 1 improved availability of clinical information resulted in prescribing efficiencies and more coordinated care; 2 improved documentation resulted in safer care; 3 efficiencies were gained by using fewer paper charts; 4 organizational support facilitated adoption; 5 transition required time; resulted in workload shift to staff; 6 hardware configurations and network stability were important in facilitating workflow; 7 e-prescribing was time-neutral or time-saving; 8 changes in patient interactions enhanced patient care but required education; 9 pharmacy

Safe prescribing: a titanic challenge

Science.gov (United States)

Routledge, Philip A

2012-01-01

The challenge to achieve safe prescribing merits the adjective ‘titanic’. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the ‘Seven C's’. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. PMID:22738396

Neuropharmacology and mental health nurse prescribers.

Science.gov (United States)

Skingsley, David; Bradley, Eleanor J; Nolan, Peter

2006-08-01

To outline the development and content of a 'top-up' neuropharmacology module for mental health nurse prescribers and consider how much pharmacology training is required to ensure effective mental health prescribing practice. Debate about the content of prescribing training courses has persisted within the United Kingdom since the mid-1980s. In early 2003 supplementary prescribing was introduced and gave mental health nurses the opportunity to become prescribers. The challenge of the nurse prescribing curriculum for universities is that they have only a short time to provide nurses from a range of backgrounds with enough knowledge to ensure that they meet agreed levels of competency for safe prescribing. There is growing concern within mental health care that the prescribing of medication in mental health services falls short of what would be deemed good practice. Over the past two decades, nurse training has increasingly adopted a psychosocial approach to nursing care raising concerns that, although nurses attending prescribing training may be able to communicate effectively with service users, they may lack the basic knowledge of biology and pharmacology to make effective decisions about medication. Following the completion of a general nurse prescribing course, mental health nurses who attended were asked to identify their specific needs during the evaluation phase. Although they had covered basic pharmacological principles in their training, they stated that they needed more specific information about drugs used in mental health; particularly how to select appropriate drug treatments for mental health conditions. This paper describes how the nurses were involved in the design of a specific module which would enable them to transfer their theoretical leaning to practice and in so doing increase their confidence in their new roles. The findings of this study suggest that the understanding and confidence of mental health nurse prescribers about the drugs they

Prescribing antibiotics in general practice:

DEFF Research Database (Denmark)

Sydenham, Rikke Vognbjerg; Pedersen, Line Bjørnskov; Plejdrup Hansen, Malene

Objectives The majority of antibiotics are prescribed from general practice. The use of broad-spectrum antibiotics increases the risk of development of bacteria resistant to antibiotic treatment. In spite of guidelines aiming to minimize the use of broad-spectrum antibiotics we see an increase...... in the use of these agents. The overall aim of the project is to explore factors influencing the decision process and the prescribing behaviour of the GPs when prescribing antibiotics. We will study the impact of microbiological testing on the choice of antibiotic. Furthermore the project will explore how...... the GPs’ prescribing behaviour is influenced by selected factors. Method The study consists of a register-based study and a questionnaire study. The register-based study is based on data from the Register of Medicinal Product Statistics (prescribed antibiotics), Statistics Denmark (socio-demographic data...

Soil heating and impact of prescribed burning

Science.gov (United States)

Stoof, Cathelijne

2016-04-01

Prescribed burning is highly uncommon in the Netherlands, where wildfire awareness is increasing but its risk management does not yet include fuel management strategies. A major exception is on two military bases, that need to burn their fields in winter and spring to prevent wildfires during summer shooting practice. Research on these very frequent burns has so far been limited to effects on biodiversity, yet site managers and policy makers have questions regarding the soil temperatures reached during these burns because of potential impact on soil properties and soil dwelling fauna. In March 2015, I therefore measured soil and litter temperatures under heath and grass vegetation during a prescribed burn on military terrain in the Netherlands. Soil and litter moisture were sampled pre- and post-fire, ash was collected, and fireline intensity was estimated from flame length. While standing vegetation was dry (0.13 g water/g biomass for grass and 0.6 g/g for heather), soil and litter were moist (0.21 cm3/cm3 and 1.6 g/g, respectively). Soil heating was therefore very limited, with maximum soil temperature at the soil-litter interface remaining being as low as 6.5 to 11.5°C, and litter temperatures reaching a maximum of 77.5°C at the top of the litter layer. As a result, any changes in physical properties like soil organic matter content and bulk density were not significant. These results are a first step towards a database of soil heating in relation to fuel load and fire intensity in this temperate country, which is not only valuable to increase understanding of the relationships between fire intensity and severity, but also instrumental in the policy debate regarding the sustainability of prescribed burns.

Drug use evaluation of antibiotics prescribed in a Jordanian hospital outpatient and emergency clinics using WHO prescribing indicators

International Nuclear Information System (INIS)

Al-Niemat, Sahar I.; Bloukh, Diana T.; Al-Harasis, Manal D.; Al-Fanek, Alen F.; Salah, Rehab K.

2008-01-01

Objective was to evaluate the use of antibiotics prescribed in hospital outpatient and emergency clinics in King Hussein Medical Centre (KHMC) using WHO prescribing indicators in an attempt to rationalize the use of antibiotics in the Royal Medical Services. We retrospectively surveyed a sample of 187,822 antibiotic prescriptions obtained from 5 outpatient pharmacies in KHMC written over the period of 3 consecutive months May 2007 to July 2007. The percentage of encounters of an antibiotic prescribed was calculated using the methodology recommended by the WHO. An additional indicator, the percentage share of different antibiotics was also included to identify the frequency prescribed from those antibiotics. The average percentage of prescriptions involving antibiotics was 35.6% out of 187,822 prescriptions surveyed. From these, 65,500 antibiotic prescriptions were observed. Penicillins most frequently amoxcillins and Quinolones most frequently ciprofloxacinllin and norfloxacillin were the most commonly prescribed antibiotics with an average percentage of 31.8% and 27.5%. The average prescribing rate for the other antibiotic categories was as follows: macrolides 5.2%, cephalosporins 16% and amoxcillins/clavulanate 5.4%. The high percentage of prescriptions involving antibiotics observed in KHMC pharmacies requires rational use of antibiotics and judicious prescribing by Military prescribers. An insight into factors influencing antibiotic prescribing patterns and adherence to antibiotic prescribing guidelines by the Military prescribers is warranted. (author)

Desenvolvimento humano: contribuições da psicologia moral

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Yves de La Taille

2007-03-01

Full Text Available Procuramos avaliar as contribuições do conhecimento acumulado pela Psicologia Moral para a compreensão do desenvolvimento humano, para sustentar a tese segundo a qual a fonte energética do dever moral precisa ser procurada não só em sentimentos exclusivamente morais, mas também em sentimentos que desempenham um papel para o próprio desenvolvimento humano no seu conjunto. Três são os passos da análise deste artigo. Em primeiro lugar, verifi car se há possibilidade de articulação entre teorias psicológicas que enfatizam a dimensão afetiva da moralidade (Freud e Durkheim e outras que enfatizam a dimensão intelectual (Piaget e Kohlberg. Em segundo lugar, uma vez constatada a impossibilidade dessa articulação, sustentar que o sentimento de vergonha, presente na moralidade mas também em outras dimensões do desenvolvimento humano, é condição necessária ao sentimento de obrigatoriedade. Finalmente, analisar se tal sentimento é passível de ser evocado como fonte energética essencial nas abordagens que enfatizam a dimensão intelectual da moralidade.

Nurse practitioner prescribing: an international perspective

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Fong J

2015-10-01

Full Text Available Jacqueline Fong,1,2 Thomas Buckley,2 Andrew Cashin3 1St George Hospital, Kogarah, 2Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia; 3School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia Background: Internationally, the delivery of care provided by nurses and midwives has undergone a significant change due to a variety of interrelated factors, including economic circumstances, a diminishing number of medical providers, the unavailability of adequate health care services in underserved and rural areas, and growing specialization among the professions. One solution to the challenges of care delivery has been the introduction of nurse practitioners (NPs and the authorization of NPs to prescribe medicines. Aim: The aim of this paper was to review the current international literature related to NP prescribing and compare the findings to the Australian context. The review focuses on literature from the United States, Canada, Europe, Australia, and New Zealand. Methods: Databases were searched from January 2000 to January 2015. The following keywords: “nurse practitioner”, “advanced nurse”, “advanced practice nurse”, “prescri*”, “Australia”, “United States America”, “UK”, “New Zealand”, “Canada”, “Europe”, “drug prescri*”, “prescri* authority”, and “prescri* legislation” were used. Findings: NPs tend to prescribe in differing contexts of practice to provide care in underserved populations and require good systems literacy to practice across complex systems. The key themes identified internationally related to NP prescribing relate to barriers to prescribing, confidence in prescribing, and the unique role of NPs in prescribing medicines, eg, the high prevalence of prescribing pain medicines in several countries, including Australia. Conclusion: Across all countries reviewed, there appears a need for further research into the organizational and

O desenvolvimento econômico da Venezuela, 1950/2006

OpenAIRE

Romina Batista de Lucena de Souza

2008-01-01

O objetivo desta tese é avaliar a contribuição do petróleo no desenvolvimento econômico da Venezuela, entre 1950/2006. Investiga-se por que uma economia rica em petróleo ainda não conseguiu industrializar-se. Seguindo os diferentes períodos governamentais, examinam-se a contribuição das políticas macroeconômicas sobre o desenvolvimento e a questão da doença holandesa e do capitalismo rentístico. Segundo a teoria da base econômica, as regiões crescem em torno de uma base exportadora, exercendo...

Safe prescribing: a titanic challenge.

Science.gov (United States)

Routledge, Philip A

2012-10-01

The challenge to achieve safe prescribing merits the adjective 'titanic'. The organisational and human errors leading to poor prescribing (e.g. underprescribing, overprescribing, misprescribing or medication errors) have parallels in the organisational and human errors that led to the loss of the Titanic 100 years ago this year. Prescribing can be adversely affected by communication failures, critical conditions, complacency, corner cutting, callowness and a lack of courage of conviction, all of which were also factors leading to the Titanic tragedy. These issues need to be addressed by a commitment to excellence, the final component of the 'Seven C's'. Optimal prescribing is dependent upon close communication and collaborative working between highly trained health professionals, whose role is to ensure maximum clinical effectiveness, whilst also protecting their patients from avoidable harm. Since humans are prone to error, and the environments in which they work are imperfect, it is not surprising that medication errors are common, occurring more often during the prescribing stage than during dispensing or administration. A commitment to excellence in prescribing includes a continued focus on lifelong learning (including interprofessional learning) in pharmacology and therapeutics. This should be accompanied by improvements in the clinical working environment of prescribers, and the encouragement of a strong safety culture (including reporting of adverse incidents as well as suspected adverse drug reactions whenever appropriate). Finally, members of the clinical team must be prepared to challenge each other, when necessary, to ensure that prescribing combines the highest likelihood of benefit with the lowest potential for harm. © 2012 The Author. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

A Technological Innovation to Reduce Prescribing Errors Based on Implementation Intentions: The Acceptability and Feasibility of MyPrescribe.

Science.gov (United States)

Keyworth, Chris; Hart, Jo; Thoong, Hong; Ferguson, Jane; Tully, Mary

2017-08-01

Although prescribing of medication in hospitals is rarely an error-free process, prescribers receive little feedback on their mistakes and ways to change future practices. Audit and feedback interventions may be an effective approach to modifying the clinical practice of health professionals, but these may pose logistical challenges when used in hospitals. Moreover, such interventions are often labor intensive. Consequently, there is a need to develop effective and innovative interventions to overcome these challenges and to improve the delivery of feedback on prescribing. Implementation intentions, which have been shown to be effective in changing behavior, link critical situations with an appropriate response; however, these have rarely been used in the context of improving prescribing practices. Semistructured qualitative interviews were conducted to evaluate the acceptability and feasibility of providing feedback on prescribing errors via MyPrescribe, a mobile-compatible website informed by implementation intentions. Data relating to 200 prescribing errors made by 52 junior doctors were collected by 11 hospital pharmacists. These errors were populated into MyPrescribe, where prescribers were able to construct their own personalized action plans. Qualitative interviews with a subsample of 15 junior doctors were used to explore issues regarding feasibility and acceptability of MyPrescribe and their experiences of using implementation intentions to construct prescribing action plans. Framework analysis was used to identify prominent themes, with findings mapped to the behavioral components of the COM-B model (capability, opportunity, motivation, and behavior) to inform the development of future interventions. MyPrescribe was perceived to be effective in providing opportunities for critical reflection on prescribing errors and to complement existing training (such as junior doctors' e-portfolio). The participants were able to provide examples of how they would use

Planos diretores: o caminho para o desenvolvimento sustentável das cidades

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Alexsandro da Miranda

2013-11-01

Full Text Available Os Planos Diretores efetivam a existência de uma legislação geral estabelecendo as normas necessárias à implementação de políticas urbanas, previstas na Constituição Federal e no Estatuto da Cidade (Lei Federal 10.257/2001 e que em seu foco principal está o desenvolvimento e a expansão urbana.  Assim, o presente artigo aborda uma breve discussão teórica do tema, suas problemáticas e contextualizações na perspectiva de fundamentá-las à luz das teorias existentes. Três principais diretrizes devem ser destacadas: o desenvolvimento sustentável, a gestão democrática da cidade e o planejamento do desenvolvimento das cidades, onde os municípios, devem, portanto, utilizar as diretrizes e instrumentos do Estatuto da Cidade com o objetivo de estabelecer as regras que propiciem o pleno desenvolvimento econômico, social, ambiental e sustentável, com vistas a garantir o direito à cidade para todos os que nela vivem.

Off-label psychotropic prescribing for young persons in medium security.

Science.gov (United States)

Haw, C; Stubbs, J

2010-10-01

Psychotropic drug prescribing for children and adolescents is frequently off-label and has increased over time and can be controversial. Psychotropic prescribing in two large UK medium secure units for young people has been studied. A total of 89 patients were included, 64% being aged less than 18 years. A total of 137 of 202 (67.8%) of prescriptions were off-label. The most common reasons for a prescription being off-label were the indication (N = 103) and the patient's age (N = 41). The main classes of drugs involved were antipsychotics (N = 59), antiepileptics as mood stabilisers (N = 22), anticholinergics and hyoscine (N = 15) and antidepressants (N = 11). Aggression (N = 48) and post-traumatic stress disorder (N = 30) were the most common off-label indications. Some antidepressant prescriptions were contrary to advice of the Committee on Safety of Medicines (CSM). Meta-analyses or randomised controlled trials supported 27% of off-label prescriptions, with lesser quality studies supporting a further 29.2% and expert opinion 38.7%, whereas for 5.1% no evidence could be found. Prescribers tended to over-estimate the level of evidence from clinical trials or extrapolated from findings in adults. They often quoted their own experience rather than expert sources to justify their prescribing practice. It is important that prescribers are fully aware of the quality of experimental data and the risk-benefit ratio when prescribing off-label for young persons. If the evidence base is limited, it is particularly important to provide information about the risks and benefits of the treatment to the patient/relatives. A second opinion may be helpful. Both target symptoms and side effects should be monitored and regularly reviewed.

DESENVOLVIMENTO DE RECURSOS DIDÁCTICOS INFORMATIZADOS NO ÂMBITO DA EDUCAÇÃO PARA O DESENVOLVIMENTO SUSTENTÁVEL. O EXEMPLO DO COURSEWARE SeRe

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Patrícia Sá

2010-02-01

Full Text Available A falta de recursos didácticos informatizados de qualidade para o 1º e 2º Ciclos do Ensino Básico (1º/2º CEB, concebidos no âmbito da Educação para o Desenvolvimento Sustentável (EDS, numa perspectiva de Ensino por Pesquisa, determinou a organização de uma equipa multidisciplinar para o desenvolvimento do «Courseware Sere - O Ser Humano e os Recursos Naturais». Ajustando alguns princípios de desenvolvimento de software, particularmente de Design Centrado noUtilizador (DCU, o trabalho da equipa multidisciplinar, constituída por elementos com diversas competências (ao nível da Didáctica das Ciências, da Tecnologia Educativa, de Design e de Programação, centrou-se no desenvolvimento de um recurso didáctico informatizado que integra várias tipologias de software, nomeadamente simulações e visualizações, com as actividades didácticas. A orientação do recurso, as temáticas propostas e as metodologias e estratégias de exploração privilegiadas fundamentam-se: i na identificação das orientações nacionais e internacionais da EDS; ii na identificação das necessidades e interesses dos professores quanto à implementação de actividades com orientação EDS (Sá, 2008; Sá e Martins, 2007, iii no paradigma de ensino por competências (Cachapuz, Sá-Chaves e Paixão, 2004 e iv no recurso a um design interactivo centrado no utilizador (Costa, Loureiro, Reis, Sá, Guerra e Vieira, 2009; Guerra, 2007. Neste artigo faz-se uma apresentação do processo de desenvolvimento do recurso didáctico, das temáticas propostas e dasmetodologias e estratégias de exploração perspectivadas pelos autores do recurso.

O TRABALHO COMO ATIVIDADE PRINCIPAL NO DESENVOLVIMENTO PSÍQUICO DO INDIVÍDUO ADULTO

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Camila Fernanda Moro Rios

2017-12-01

Full Text Available Este artigo visa analisar, por meio da revisão teórica de autores clássicos e contemporâneos da psicologia histórico-cultural, o trabalho como atividade principal na vida adulta, isto é, como a atividade que orienta as principais mudanças no psiquismo humano e na personalidade nessa idade. Para tanto, abstrai e generaliza elementos constantes nos estudos sobre periodização do desenvolvimento psíquico humano. Por um lado, identifica os conteúdos e processos psicológicos que, produzidos pelo trabalho, evidenciam sua relevância para o desenvolvimento do indivíduo adulto. Por outro, aborda os processos de alienação inerentes à sociedade capitalista, que alienam o trabalho como atividade principal. Assim, o trabalho se apresenta, dialeticamente, como atividade humanizadora e alienada. Entende-se que este estudo contribui para o avanço teórico-metodológico da psicologia histórico-cultural por abordar a questão do trabalho como atividade principal, uma discussão que se encontra ainda incipiente e pouco sistematizada. Além disso, supera o enfoque dos estudos sobre o desenvolvimento centrados na infância e reitera o rompimento com a perspectiva maturacionista de que a vida adulta é um período de estagnação do desenvolvimento. Pela análise do trabalho como atividade principal conclui-se que o desenvolvimento psicológico, produzido na vida adulta, se expressa, principalmente, por uma série de aquisições de habilidades e capacidades, pelo exercício da criatividade, por uma complexa reestruturação da esfera afetivo-motivacional da personalidade, pelo desenvolvimento da autoconsciência e pelo movimento dialético da consciência de classe, que tensiona a contradição entre o polo humanizador e o polo alienado/alienante do trabalho numa sociedade que limita e empobrece esse mesmo desenvolvimento.

Prescribing practices amid the OxyContin crisis: examining the effect of print media coverage on opioid prescribing among physicians.

Science.gov (United States)

Borwein, Alexandra; Kephart, George; Whelan, Emma; Asbridge, Mark

2013-12-01

The pain medication OxyContin (hereafter referred to as oxycodone extended release) has been the subject of sustained, and largely negative, media attention in recent years. We sought to determine whether media coverage of oxycodone extended release in North American newspapers has led to changes in prescribing of the drug in Nova Scotia, Canada. An interrupted time-series design examined the effect of media attention on physicians' monthly prescribing of opioids. The outcome measures were, for each physician, the monthly proportions of all opioids prescribed and the proportion of strong opioids prescribed that were for oxycodone extended release. The exposure of interest was media attention defined as the number of articles published each month in 27 North American newspapers. Variations in media effects by provider characteristics (specialty, prescribing volume, and region) were assessed. Within-provider changes in the prescribing of oxycodone extended release in Nova Scotia were observed, and they followed changes in media coverage. Oxycodone extended release prescribing rose steadily prior to receiving media attention. Following peak media attention in the United States, the prescribing of oxycodone extended release slowed. Likewise, following peak coverage in Canadian newspapers, the prescribing of oxycodone extended release declined. These patterns were observed across prescriber specialties and by prescriber volume, though the magnitude of change in prescribing varied. This study demonstrates that print media reporting of oxycodone extended release in North American newspapers, and its continued portrayal as a social problem, coincided with reductions in the prescribing of oxycodone extended release by physicians in Nova Scotia. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations

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Neda Ratanawongsa

2017-01-01

Full Text Available Widespread electronic health record (EHR implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1 the adoption of RxNorm; (2 standardized naming and picklist options for high alert medications such as insulin; (3 the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4 enhanced bidirectional communication with pharmacy partners; and (5 informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations.

Prescribing Clinicians’ Perspectives on Evidence-Based Psychotherapy for Posttraumatic Stress Disorder

Science.gov (United States)

Barnett, Erin R.; Bernardy, Nancy C.; Jenkyn, Aaron B.; Parker, Louise E.; Lund, Brian C.; Alexander, Bruce; Friedman, Matthew J.

2014-01-01

Evidence-based psychotherapies (EBP) for Posttraumatic Stress Disorder are not utilized to their full extent within the Department of Veterans Affairs (VA). VA provides care to many persons with PTSD and has been in the forefront of clinical practice guidelines and EBP training and dissemination. Yet VA continues to find EBP implementation difficult. Veterans with PTSD often initially present to prescribing clinicians, who then help make care decisions. It is therefore critical that these clinicians correctly screen and triage appropriate mental health care. The purpose of this study was to assess VA prescribing clinicians’ knowledge, perceptions, and referral behaviors related to EBPs for PTSD and to identify facilitators and barriers to implementing EBPs within VA. We conducted qualitative interviews with 26 VA prescribing clinicians. Limited access to EBPs was the most commonly noted barrier. The clinicians we interviewed also held specific beliefs and behaviors that may delay or deter EBPs. Strategies to improve utilization also emerged. Findings suggest the need for increased access to EBPs, training to optimize the role of prescribing clinicians in helping Veterans with PTSD make appropriate care decisions, and specific organizational changes to facilitate access and effective referral systems for EBPs. PMID:25431445

O coaching enquanto prática de desenvolvimento de recursos humanos

OpenAIRE

Soares, Luciana Rocha

2013-01-01

A presente investigação visa identificar os benefícios do coaching para o desenvolvimento de recursos humanos, procurando entender como esta prática contribui para o desenvolvimento de competências, para a melhoria de desempenhos e resultados organizacionais. Sendo uma pesquisa de natureza qualitativa, foram realizadas entrevistas semiestruturadas a 10 coaches profissionais, as quais foram submetidas a análise de conteúdo. Não representativos da população, os resultados obti...

A RCT evaluating the effectiveness and cost-effectiveness of academic detailing versus postal prescribing feedback in changing GP antibiotic prescribing.

LENUS (Irish Health Repository)

Naughton, Corina

2009-10-01

The aim of this study is to evaluate the effectiveness of academic detailing (AD) plus postal prescribing feedback versus postal prescribing feedback alone in reducing: (i) the overall rate of antibiotic; and (ii) proportion of second-line antibiotic prescribing. In addition, the cost-effectiveness of an outreach prescriber adviser service versus a postal prescribing feedback service was evaluated.

Os limites do desenvolvimento e do turismo

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Menezes Teixeira Coriolano, Luzia Neide

2003-01-01

Full Text Available This paper is a historical analysis of the background and evolution of the concept of development and the limits to development, supported by links with economic science, thus pervading all social sciences. The assumptions of developmentalist theories, the so-called modernization theories, are shown and identified as traditional, conservative and consensual, thus differing from critical theories which adopt the assumptions of historical materialism. The paper examines those aspects of globalization which pertain to new approaches to development, whereby tourism becomes a link between the local and the global. The study explains how and why development is an unequal and joint process. Underdevelopment is a result of the structural adjustments which determine concentration of wealth and income, generating poverty as the ultimate expression of social inequality. It is shown that development only takes place when people benefit, when a human scale is reached, that tourism can both connect with concentrated economic growth and promote social development, otherwise known as local development

Prescribed Burning and Erosion Potential in Mixed Hardwood Forests of Southern Illinois

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Gurbir Singh

2017-04-01

Full Text Available Prescribed fire has several benefits for managing forest ecosystems including reduction of fuel loading and invasive species and enhanced regeneration of desirable tree species. Along with these benefits there are some limitations like nutrient and sediment loss which have not been studied extensively in mixed hardwood forests. The objective of our research was to quantify the amount of sediment movement occurring on a watershed scale due to prescribed fire in a southern Illinois mixed hardwood ecosystem. The research site was located at Trail of Tears State Forest in western Union county, IL, USA and included five watershed pairs. One watershed in each pair was randomly assigned the prescribed burn treatment and the other remained as control (i.e., unburned. The prescribed burn treatment significantly reduced the litter depth with 12.6%–31.5% litter remaining in the prescribed burn treatment watersheds. When data were combined across all watersheds, no significant differences were obtained between burn treatment and control watershed for total suspended solids and sediment concentrations or loads. The annual sediment losses varied from 1.41 to 90.54 kg·ha−1·year−1 in the four prescribed burn watersheds and 0.81 to 2.54 kg·ha−1·year−1 in the four control watersheds. Prescribed burn watershed 7 showed an average soil sediment loss of 4.2 mm, whereas control watershed 8 showed an average accumulation of sediments (9.9 mm, possibly due to steeper slopes. Prescribed burning did not cause a significant increase in soil erosion and sediment loss and can be considered acceptable in managing mixed hardwood forests of Ozark uplands and the Shawnee Hills physiographic regions of southern Illinois.

Desenvolvimento Policêntrico na Europa : Uma reflexao critica sobre um conceito de politicas normativas

NARCIS (Netherlands)

Meijers, E.J.

Durante a última década, o desenvolvimento policêntrico tornou-se um conceito-chave no desenvolvimento territorial europeu. Em muitos aspectos, é um conceito difuso que significa diferentes coisas para diferentes pessoas em diferentes escalas espaciais. Neste artigo, analisamos as variadas

Implementing nurse prescribing: a case study in diabetes.

Science.gov (United States)

Stenner, Karen; Carey, Nicola; Courtenay, Molly

2010-03-01

This paper is a report of a study exploring the views of nurses and team members on the implementation of nurse prescribing in diabetes services. Nurse prescribing is adopted as a means of improving service efficiency, particularly where demand outstretches resources. Although factors that support nurse prescribing have been identified, it is not known how these function within specific contexts. This is important as its uptake and use varies according to mode of prescribing and area of practice. A case study was undertaken in nine practice settings across England where nurses prescribed medicines for patients with diabetes. Thematic analysis was conducted on qualitative data from 31 semi-structured interviews undertaken between 2007 and 2008. Participants were qualified nurse prescribers, administrative staff, physicians and non-nurse prescribers. Nurses prescribed more often following the expansion of nurse independent prescribing rights in 2006. Initial implementation problems had been resolved and few current problems were reported. As nurses' roles were well-established, no major alterations to service provision were required to implement nurse prescribing. Access to formal and informal resources for support and training were available. Participants were accepting and supportive of this initiative to improve the efficiency of diabetes services. The main factors that promoted implementation of nurse prescribing in this setting were the ability to prescribe independently, acceptance of the prescribing role, good working relationships between doctors and nurses, and sound organizational and interpersonal support. The history of established nursing roles in diabetes care, and increasing service demand, meant that these diabetes services were primed to assimilate nurse prescribing.

Psychiatric Prescribers' Experiences With Doctor Shoppers.

Science.gov (United States)

Worley, Julie; Johnson, Mary; Karnik, Niranjan

2015-01-01

Doctor shopping is a primary method of prescription medication diversion. After opioids, benzodiazepines and stimulants are the next most common prescription medications used nonmedically. Studies have shown that patients who engage in doctor shopping find it fun, exciting, and easy to do. There is a lack of research on the prescriber's perspective on the phenomenon of doctor shopping. This study investigates the experiences of prescribers in psychiatry with patients who engage in doctor shopping. Fifteen prescribers including psychiatrists and psychiatric nurse practitioners working in outpatient psychiatry were interviewed to elicit detailed information about their experiences with patients who engage in doctor shopping. Themes found throughout the interview were that psychiatric prescribers' experience with patients who engage in doctor shopping includes (a) detecting red flags, (b) negative emotional responding, (c) addressing the patient and the problem, and (d) inconsistently implementing precautions. When red flags were detected when prescribing controlled drugs, prescribers in psychiatry experienced both their own negative emotional responses such as disappointment and resentment as well as the negative emotions of the patients such as anger and other extreme emotional responses. Psychiatric prescribers responded to patient's doctor shopping in a variety of ways such as changing their practice, discharging the patients or taking steps to not accept certain patients identified as being at risk for doctor shopping, as well as by talking to the patient and trying to offer them help. Despite experiencing doctor shopping, the prescribers inconsistently implemented precautionary measures such as checking prescription drug monitoring programs. © The Author(s) 2015.

A model of methods for influencing prescribing: Part I. A review of prescribing models, persuasion theories, and administrative and educational methods.

Science.gov (United States)

Raisch, D W

1990-04-01

The purpose of this literature review is to develop a model of methods to be used to influence prescribing. Four bodies of literature were identified as being important for developing the model: (1) Theoretical prescribing models furnish information concerning factors that affect prescribing and how prescribing decisions are made. (2) Theories of persuasion provide insight into important components of educational communications. (3) Research articles of programs to improve prescribing identify types of programs that have been found to be successful. (4) Theories of human inference describe how judgments are formulated and identify errors in judgment that can play a role in prescribing. This review is presented in two parts. This article reviews prescribing models, theories of persuasion, studies of administrative programs to control prescribing, and sub-optimally designed studies of educational efforts to influence drug prescribing.

Emissions from Combustion of Open Area Sources: Prescribed Forest and Agricultural Burns

Science.gov (United States)

Emissions from wildfires and prescribed forest and agricultural burns generate a variety of emissions that can cause adverse health effects for humans, contribute to climate change, and decrease visibility. Only limited pollutant data are available for these sources, particularly...

Método Ágil aplicado ao desenvolvimento de software confiável baseado em componentes

OpenAIRE

Alan Braz

2013-01-01

Resumo: Os Métodos Ágeis, ou Desenvolvimento Ágil de Software (DAS), tem se popularizado, na última década, por meio de métodos como Extreme Programming (XP) e Scrum e isso fez com que fossem aplicadas no desenvolvimento de sistemas computacionais de diversos tamanhos, complexidades técnica e de domínio, e de rigor quanto à confiabilidade. Esse fato evidencia a necessidade de processos de desenvolvimento de software que sejam mais rigorosos e que possuam uma quantidade adequada de modelagem e...

O desenvolvimento do conhecimento na Pesquisa e Desenvolvimento e o registro através de patentes no Brasil – uma experiência profissional

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Cynthia Helena Soares Bouças Teixeira

2017-11-01

Full Text Available Este trabalho tem como objetivo fornecer um detalhamento sobre o processo de busca do conhecimento, partindo de uma ferramenta básica que é a informação. No contexto que envolve Pesquisa & Desenvolvimento, o conhecimento pode ser estruturado para o desenvolvimento de novas tecnologias, produtos ou processos, em que o registro do conhecimento pode ocorrer  através das patentes. Dado que é preciso conhecer a legislação do país de depósito,trataremos mais especificamente do sistema de registro de patentes brasileiro denominado Instituto Nacional da Propriedade Intelectual – INPI. As reflexões apresentadas são provenientes de uma experiência profissional.

Desenvolvimento moral: considerações teóricas a partir de uma abordagem sociocultural construtivista

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Martins Lincoln Coimbra

2001-01-01

Full Text Available Partindo da análise de trabalhos tradicionalmente realizados na área de desenvolvimento moral, o artigo sinaliza a necessidade de desenvolver uma abordagem teórica que trate o tema dentro de um enfoque que considere os aspectos socioculturais, cognitivos e afetivos. A questão central reside em abordar de forma sistêmica e integrada a dinâmica do desenvolvimento moral do indivíduo, resgatando a dimensão interativa e contextual envolvida na resolução dos conflitos morais e no desenvolvimento de crenças e valores. O trabalho parte dos pressupostos da perspectiva histórica socio-cultural construtivista do desenvolvimento humano, explicitando as exigências metodológicas implicadas na adoção dos conceitos e categorias utilizados no âmbito de tal perspectiva.

Desenvolvimento moral: considerações teóricas a partir de uma abordagem sociocultural construtivista

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Lincoln Coimbra Martins

Full Text Available Partindo da análise de trabalhos tradicionalmente realizados na área de desenvolvimento moral, o artigo sinaliza a necessidade de desenvolver uma abordagem teórica que trate o tema dentro de um enfoque que considere os aspectos socioculturais, cognitivos e afetivos. A questão central reside em abordar de forma sistêmica e integrada a dinâmica do desenvolvimento moral do indivíduo, resgatando a dimensão interativa e contextual envolvida na resolução dos conflitos morais e no desenvolvimento de crenças e valores. O trabalho parte dos pressupostos da perspectiva histórica socio-cultural construtivista do desenvolvimento humano, explicitando as exigências metodológicas implicadas na adoção dos conceitos e categorias utilizados no âmbito de tal perspectiva.

Facilitators and barriers to non-medical prescribing - A systematic review and thematic synthesis.

Science.gov (United States)

Graham-Clarke, Emma; Rushton, Alison; Noblet, Timothy; Marriott, John

2018-01-01

Non-medical prescribing has the potential to deliver innovative healthcare within limited finances. However, uptake has been slow, and a proportion of non-medical prescribers do not use the qualification. This systematic review aimed to describe the facilitators and barriers to non-medical prescribing in the United Kingdom. The systematic review and thematic analysis included qualitative and mixed methods papers reporting facilitators and barriers to independent non-medical prescribing in the United Kingdom. The following databases were searched to identify relevant papers: AMED, ASSIA, BNI, CINAHL, EMBASE, ERIC, MEDLINE, Open Grey, Open access theses and dissertations, and Web of Science. Papers published between 2006 and March 2017 were included. Studies were quality assessed using a validated tool (QATSDD), then underwent thematic analysis. The protocol was registered with PROSPERO (CRD42015019786). Of 3991 potentially relevant identified studies, 42 were eligible for inclusion. The studies were generally of moderate quality (83%), and most (71%) were published 2007-2012. The nursing profession dominated the studies (30/42). Thematic analysis identified three overarching themes: non-medical prescriber, human factors, and organisational aspects. Each theme consisted of several sub-themes; the four most highly mentioned were 'medical professionals', 'area of competence', 'impact on time' and 'service'. Sub-themes were frequently interdependent on each other, having the potential to act as a barrier or facilitator depending on circumstances. Addressing the identified themes and subthemes enables strategies to be developed to support and optimise non-medical prescribing. Further research is required to identify if similar themes are encountered by other non-medical prescribing groups than nurses and pharmacists.

Antimalarial prescribing patterns in state hospitals and selected ...

African Journals Online (AJOL)

slowdown of progression to resistance could be achieved by improving prescribing practice, drug quality, and patient compliance. Objective: To determine the antimalarial prescribing pattern and to assess rational prescribing of chloroquine by prescribers in government hospitals and parastatals in Lagos State. Methods: ...

Avaliação do crescimento e desenvolvimento de crianças institucionalizadas

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Caroline Magna Pessoa Chaves

2013-10-01

Full Text Available O estudo objetivou avaliar o crescimento e desenvolvimento de crianças de 0 a 6 anos institucionalizadas. Abordagem descritiva, transversal e de natureza quantitativa. Foi realizado em um abrigo da Secretaria do Trabalho e Desenvolvimento Social do Governo do Estado do Ceará, nos meses de março e abril de 2011. A amostra foi composta por 44 crianças. Prevaleceram crianças de sexo masculino (59,1%; faixa etária entre 24 a 72 meses (56,8%, e tempo de abrigamento superior a um ano (72,7%. Verificou-se que as crianças estavam na faixa de normalidade nutricional. Porém, 65,9% das crianças não alcançaram pelo menos um dos marcos do desenvolvimento propostos pelo Ministério da Saúde. O estudo possibilitou uma reflexão sobre como as crianças residentes em abrigos estão sendo assistidas pela equipe de saúde, tornando-se necessário realizar o acompanhamento de seu crescimento e desenvolvimento, a fim de intervir sobre as alterações encontradas.

Introduction to prescribed fires in Southern ecosystems

Science.gov (United States)

Thomas A. Waldrop; Scott L. Goodrick

2012-01-01

This publication is a guide for resource managers on planning and executing prescribed burns in Southern forests and grasslands. It includes explanations of reasons for prescribed burning, environmental effects, weather, and techniques as well as general information on prescribed burning.

Benzodiazepines - Their role in aggression and why GPs should prescribe with caution.

Science.gov (United States)

Jones, Katy A; Nielsen, Suzanne; Bruno, Raimondo; Frei, Matthew; Lubman, Dan I

2011-11-01

Benzodiazepines are widely prescribed in Australia, despite concerns about their potential for abuse and dependence. Paradoxical reactions, disinhibition and amnesia are all associated with benzodiazepine use, misuse and intoxication. While violent and aggressive behaviour may be a consequence of such disinhibition, there is limited information available regarding the links between benzodiazepine use and violence. This article aims to examine the existing evidence on the relationship between benzodiazepines, violence and aggression. While current evidence suggests that benzodiazepines rarely induce violence, it is important to note that the available literature is limited in its scope and that benzodiazepine related violence is often severe and of potential concern to frontline workers. Mediating risk factors for benzodiazepine related violence include concurrent alcohol use, benzodiazepine dose, a history of aggression and underlying impulsivity. Comprehensive assessment and alternate nonpharmacological treatment options should be considered before prescribing benzodiazepines within primary care.

Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia.

Science.gov (United States)

Ab Rahman, Norazida; Teng, Cheong Lieng; Sivasampu, Sheamini

2016-05-17

Antibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia. We used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014. NMCS contained demographic, diagnoses and prescribing from 129 public clinics and 416 private clinics. We identified all encounters who were prescribed antibiotic and analyse the prescribing rate, types of antibiotics, and diagnoses that resulted in antibiotic. Five thousand eight hundred ten encounters were prescribed antibiotics; antibiotic prescribing rate was 21.1 % (public clinics 6.8 %, private clinics 30.8 %). Antibiotic prescribing was higher in private clinics where they contributed almost 87 % of antibiotics prescribed in primary care. Upper respiratory tract infection (URTI) was the most frequent diagnosis in patients receiving antibiotic therapy and accounted for 49.2 % of prescriptions. Of the patients diagnosed with URTI, 46.2 % received antibiotic treatment (public 16.8 %, private 57.7 %). Penicillins, cephalosporins and macrolides were the most commonly prescribed antibiotics and accounted for 30.7, 23.6 and 16.0 % of all antibiotics, respectively. More recently available broad-spectrum antibiotics such as azithromycin and quinolones were more frequently prescribed in private clinics. Antibiotic prescribing rates are high in both public and private primary care settings in Malaysia, especially in the latter. This study provides evidence of excessive and inappropriate antibiotic prescribing for self-limiting conditions. These data highlights the needs for more concerted interventions targeting both prescribers and public. Improvement strategies should focus on reducing

Gaseous and particulate emissions from prescribed burning in Georgia.

Science.gov (United States)

Lee, Sangil; Baumann, Karsten; Schauer, James J; Sheesley, Rebecca J; Naeher, Luke P; Meinardi, Simone; Blake, Donald R; Edgerton, Eric S; Russell, Armistead G; Clements, Mark

2005-12-01

Prescribed burning is a significant source of fine particulate matter (PM2.5) in the southeastern United States. However, limited data exist on the emission characteristics from this source. Various organic and inorganic compounds both in the gas and particle phase were measured in the emissions of prescribed burnings conducted at two pine-dominated forest areas in Georgia. The measurements of volatile organic compounds (VOCs) and PM2.5 allowed the determination of emission factors for the flaming and smoldering stages of prescribed burnings. The VOC emission factors from smoldering were distinctly higher than those from flaming except for ethene, ethyne, and organic nitrate compounds. VOC emission factors show that emissions of certain aromatic compounds and terpenes such as alpha and beta-pinenes, which are important precursors for secondary organic aerosol (SOA), are much higher from active prescribed burnings than from fireplace wood and laboratory open burning studies. Levoglucosan is the major particulate organic compound (POC) emitted for all these studies, though its emission relative to total organic carbon (mg/g OC) differs significantly. Furthermore, cholesterol, an important fingerprint for meat cooking, was observed only in our in situ study indicating a significant release from the soil and soil organisms during open burning. Source apportionment of ambient primary fine particulate OC measured at two urban receptor locations 20-25 km downwind yields 74 +/- 11% during and immediately after the burns using our new in situ profile. In comparison with the previous source profile from laboratory simulations, however, this OC contribution is on average 27 +/- 5% lower.

Meio ambiente, capitalismo e desenvolvimento sustentável: a arquitetura de um matrimônio duvidoso

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François M. P. Gavard

2009-01-01

Full Text Available http://dx.doi.org/10.5007/1806-5023.2009v6n3p25 A revolução no pensamento e na relação do homem com o meio ambiente advinda do Iluminismo desencadeou durante a Modernidade um processo de desenvolvimento econômico e tecnológico que ao alcançar o século XX demonstrou-se problemático trazendo a perspectiva da finitude e do limite de volta às consciências. Movimentos sociais se organizaram reivindicando a conservação do meio ambiente e a ciência e o capitalismo foram apontados com responsáveis pela destruição do ambiente natural. O debate em torno da problemática ambiental era pautado pelo impasse entre as posições antagônicas de “ambientalistas” e “desenvolvimentistas”. Na busca da superação deste impasse foram articulados os conceitos de “Ecodesenvolvimento” e posteriormente o de Desenvolvimento Sustentável. O primeiro foi rejeitado devido ao seu conteúdo excessivamente político e de partir de premissas que contrariavam os interesses da economia mundial. O segundo ganhou proeminência no discurso ambiental e teve ampla aceitação nos mais diversos setores devido ao seu caráter conciliador que afirmava a possibilidade de se alcançar um tipo de desenvolvimento capaz de contemplar os aspectos sociais, econômicos e ecológicos. Ainda que elaborado de maneira vaga e alvo de suspeita de mera estratégia discursiva.

69-74 A Retrospective Analysis of Prescribing Prac

African Journals Online (AJOL)

user

A Retrospective Analysis of Prescribing Practice Based on WHO Prescribing Indicators at Four. Selected Hospitals of West ... Key words: World Health Organization, prescribing indicators, rational drug use. INTRODUCTION. Indicators of ... factors, the risk of irrational prescribing could raise several folds. Irrational use of ...

Rational use of medicine in dentistry: do dentists prescribe antibiotics in appropriate indications?

Science.gov (United States)

Koyuncuoglu, Cenker Z; Aydin, Mehtap; Kirmizi, N Ipek; Aydin, Volkan; Aksoy, Mesil; Isli, Fatma; Akici, Ahmet

2017-08-01

There are concerns regarding appropriate use of antibiotics in dentistry practice. Data on dental antibiotic prescribing patterns by dentists is relatively limited. This nationwide study aimed to examine dentists' antibiotic prescriptions in a diagnosis-based manner in Turkey. This retrospective study on utilization of systemic antibiotics for dental problems was based on the national health data of the dentists obtained from Prescription Information System between January 2013 and August 2015. Only those prescriptions containing single diagnosis and at least one systemic antibiotic were included in the study. Antibiotic prescribing was compared by diagnoses and expertise of dentists. A total of 9,293,410 antibiotics were detected in 9,214,956 prescriptions that contained "single diagnosis and at least one antibiotic." The number of antibiotics per prescription was 1.01. "Periapical abscess without sinus" (28.1%), "dental examination" (20.7%), and "dental caries" (16.2%) were the three most common indications in which antibiotics were prescribed by dentists. While only 3.4% of antibiotics were prescribed upon the single and appropriate "cellulitis and abscess of mouth" diagnosis, the remaining 96.6% was prescribed for irrational/uncertain indications. Consistent in all diagnoses, "amoxicillin + enzyme inhibitor" (58.6%) was the mainly prescribed antibiotic. Analysis of the most preferred "amoxicillin + enzyme inhibitor" prescriptions by expertise of dentists showed significantly much higher prescription rates among Group A specialists and Group B specialists (67.0 and 67.8%, respectively) than those in unidentified dental practitioners (58.2%, p < 0.0001). This study showed that dentists prescribed antibiotics in an arbitrary and mostly unnecessary manner. In general, their antibiotic choices for examined diagnoses could be regarded as irrational. These results indicate the urgent need for improvement of rational antibiotic prescribing habits of dentists.

Abordagem grassroots e resistência: atualizando a concepção de desenvolvimento sustentável

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Augusto Marcos Carvalho de Sena

Full Text Available Resumo Em contrapartida às especificidades impositivas do modelo de produção capitalista - incluindo-se nesse modelo os meandros de arranjos produtivos que inserem o meio ambiente enquanto alinhado à versão tríplice da concepção tradicional de desenvolvimento sustentável -, tem surgido uma massa crítica de literatura focada na resistência ao modo de funcionamento do capitalismo ocidental. Em relação à teoria, economia solidária (pilar econômico, movimentos sociais (pilar social, ecologia política (pilar ambiental e raízes culturais (pilar cultural são aparatos importantes que não devem ficar à margem na estruturação de uma concepção alternativa do desenvolvimento sustentável. Tais aparatos são considerados elementos de resistência, visto terem fatores diferenciados quando comparados com as características tradicionais dos pilares da criticada concepção de desenvolvimento sustentável. Assim, o objetivo do presente ensaio teórico é conceber alternativas à concepção padrão do desenvolvimento sustentável, considerando aspectos da abordagem grassroots importantes para esse propósito. A contribuição é relevante tendo em vista a consideração de aspectos alternativos e complementares envolvidos na leitura da atualização conjecturada. Os prospectos do desenvolvimento grassroots têm sido usados como guia prático em ações de desenvolvimento local envolvendo comunidades menos desenvolvidas em várias partes do mundo, sem a conjectura que sinaliza para elementos conceituais que podem oferecer uma conformação alternativa à concepção do desenvolvimento sustentável. Conclui-se que a versão tradicional do desenvolvimento sustentável pode ser atualizada com elementos alternativos advindos da abordagem grassroots.

Prescribing Antibiotics

DEFF Research Database (Denmark)

Pedersen, Inge Kryger; Jepsen, Kim Sune

2018-01-01

The medical professions will lose an indispensable tool in clinical practice if even simple infections cannot be cured because antibiotics have lost effectiveness. This article presents results from an exploratory enquiry into “good doctoring” in the case of antibiotic prescribing at a time when...... the knowledge base in the healthcare field is shifting. Drawing on in-depth interviews about diagnosing and prescribing, the article demonstrates how the problem of antimicrobial resistance is understood and engaged with by Danish general practitioners. When general practitioners speak of managing “non......-medical issues,” they refer to routines, clinical expertise, experiences with their patients, and decision-making based more on contextual circumstances than molecular conditions—and on the fact that such conditions can be hard to assess. This article’s contribution to knowledge about how new and global health...

Medication errors: prescribing faults and prescription errors.

Science.gov (United States)

Velo, Giampaolo P; Minuz, Pietro

2009-06-01

1. Medication errors are common in general practice and in hospitals. Both errors in the act of writing (prescription errors) and prescribing faults due to erroneous medical decisions can result in harm to patients. 2. Any step in the prescribing process can generate errors. Slips, lapses, or mistakes are sources of errors, as in unintended omissions in the transcription of drugs. Faults in dose selection, omitted transcription, and poor handwriting are common. 3. Inadequate knowledge or competence and incomplete information about clinical characteristics and previous treatment of individual patients can result in prescribing faults, including the use of potentially inappropriate medications. 4. An unsafe working environment, complex or undefined procedures, and inadequate communication among health-care personnel, particularly between doctors and nurses, have been identified as important underlying factors that contribute to prescription errors and prescribing faults. 5. Active interventions aimed at reducing prescription errors and prescribing faults are strongly recommended. These should be focused on the education and training of prescribers and the use of on-line aids. The complexity of the prescribing procedure should be reduced by introducing automated systems or uniform prescribing charts, in order to avoid transcription and omission errors. Feedback control systems and immediate review of prescriptions, which can be performed with the assistance of a hospital pharmacist, are also helpful. Audits should be performed periodically.

What do providers want to know about opioid prescribing? A qualitative analysis of their questions.

Science.gov (United States)

Cushman, Phoebe A; Liebschutz, Jane M; Hodgkin, Joseph G; Shanahan, Christopher W; White, Julie L; Hardesty, Ilana; Alford, Daniel P

2017-01-01

In 2012, the US Food and Drug Administration (FDA) responded to the opioid crisis with a Risk Evaluation and Mitigation Strategy, requiring manufacturers of extended-release/long-acting opioids to fund continuing medical education based on the "FDA Blueprint for Prescriber Education." Topics in the Blueprint are "Assessing Patients for Treatment," "Initiating Therapy, Modifying Dosing, and Discontinuing Use," "Managing Therapy," "Counseling Patients and Caregivers about Safe Use," "General Drug Information," and "Specific Drug Information." Based on the FDA Blueprint, Boston University School of Medicine's "Safe and Competent Opioid Prescribing Education" (SCOPE of Pain) offers live trainings for physicians and other prescribers. During trainings, participants submit written questions about the curriculum and/or their clinical experiences. The objective was to compare themes that arose from questions asked by SCOPE of Pain participants with content of the FDA Blueprint in order to evaluate how well the Blueprint answers prescribers' concerns. The authors conducted qualitative analyses of all 1309 questions submitted by participants in 29 trainings across 16 states from May 2013 to May 2015, using conventional content analysis to code the questions. Themes that emerged from participants' questions were then compared with the Blueprint. Most themes fell into the topic categories of the Blueprint. Five main themes diverged: Participants sought information on (1) safe alternatives to opioids, (2) overcoming barriers to safe opioid prescribing, (3) government regulations of opioid prescribing, (4) the role of marijuana in opioid prescribing, and (5) maintaining a positive provider-patient relationship while prescribing opioids. In addition to learning the mechanics of safe opioid prescribing, providers want to understand government regulations and effective patient communication skills. Aware of the limitations of opioids in managing chronic pain, providers seek advice

Nacionalismo e desenvolvimento

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Paulo Nogueira Batista Jr.

2007-03-01

Full Text Available Este texto discute o nacionalismo, tomando emprestadas algumas proposições de um filósofo declarada e radicalmente antinacionalista, Friedrich Nietzsche. Procura-se argumentar que, ressalvados os raros casos de integração regional profunda, o nacionalismo é, na prática, o único caminho para o desenvolvimento econômico e a melhoria das condições de vida das populações na periferia da economia internacional.This paper discusses nationalism, borrowing some propositions from a philosopher who was openly and radically antinationalist, Friedrich Nietzsche. It argues that, with the exception of the rare cases of deep regional integration, nationalism is, in practice, the only route to economic development and the improvement of the standards of living of populations in the periphery of the international economy.

A ranking system for prescribed burn prioritization in Table Mountain National Park, South Africa.

Science.gov (United States)

Cowell, Carly Ruth; Cheney, Chad

2017-04-01

To aid prescribed burn decision making in Table Mountain National Park, in South Africa a priority ranking system was tested. Historically a wildfire suppression strategy was adopted due to wildfires threatening urban areas close to the park, with few prescribed burns conducted. A large percentage of vegetation across the park exceeded the ecological threshold of 15 years. We held a multidisciplinary workshop, to prioritize areas for prescribed burning. Fire Management Blocks were mapped and assessed using the following seven categories: (1) ecological, (2) management, (3) tourism, (4) infrastructure, (5) invasive alien vegetation, (6) wildland-urban interface and (7) heritage. A priority ranking system was used to score each block. The oldest or most threatened vegetation types were not necessarily the top priority blocks. Selected blocks were burnt and burning fewer large blocks proved more effective economically, ecologically and practically due to the limited burning days permitted. The prioritization process was efficient as it could be updated annually following prescribed burns and wildfire incidents. Integration of prescribed burn planning and wildfire suppression strategies resulted in a reduction in operational costs. We recommend protected areas make use of a priority ranking system developed with expert knowledge and stakeholder engagement to determine objective prescribed burn plans. Copyright © 2017 Elsevier Ltd. All rights reserved.

Medicare Provider Data - Part D Prescriber

Data.gov (United States)

U.S. Department of Health & Human Services — The Part D Prescriber Public Use File (PUF) provides information on prescription drugs prescribed by individual physicians and other health care providers and paid...

The quality of outpatient antimicrobial prescribing

DEFF Research Database (Denmark)

Malo, Sara; Bjerrum, Lars; Feja, Cristina

2013-01-01

The aim of the study was to analyse and compare the quality of outpatient antimicrobial prescribing in Denmark and Aragón (in northeastern Spain), with the objective of assessing inappropriate prescribing....

Saúde e desenvolvimento Healthcare and development

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Ana Luiza D'Ávila Viana

2007-11-01

Full Text Available Considerando que os modernos sistemas de saúde são o resultado da complexa interação de processos econômicos, políticos e sociais, o objetivo do trabalho é discutir a relação entre saúde e desenvolvimento no Brasil, mostrando que o esgotamento do modelo liberal de política econômica abre nova perspectiva para a retomada do desenvolvimento, entendido como combinação entre crescimento da economia, mudanças na estrutura produtiva e melhora das condições de vida da população. O complexo produtivo da saúde joga papel decisivo nesse processo, pois constitui um campo em que inovação tecnológica e acumulação de capital geram oportunidades de investimento, trabalho e renda, além de produzir avanços importantes para melhorar o estado de saúde das pessoas. A recente adoção de políticas públicas voltadas para articular, de forma positiva, aspectos da política econômica e da política social revela que a questão do desenvolvimento nacional ganhou nova centralidade na agenda governamental, o que abre a perspectiva de maior integração entre a lógica econômica e a lógica sanitária. Entretanto, é preciso reconhecer que o Brasil ainda não logrou alcançar uma associação virtuosa entre saúde e desenvolvimento.As modern healthcare systems are the outcome of complex interactions among economic, political and social processes, the purpose of this paper is to discuss the links between health and development in Brazil, showing that the depletion of the liberal economic policy model paves the way for a return to development, understood as a blend of economic growth, changes in the production structure and better living standards. The healthcare production complex plays a crucial role in this process, as a field where technological innovation and capital build-up generate opportunities for investment, work and income, in addition to spurring major steps forward in terms of upgrading individual health. The recent adoption of

Impact of pharmacists assisting with prescribing and undertaking medication review on oxycodone prescribing and supply for patients discharged from surgical wards.

Science.gov (United States)

Tran, T; Taylor, S E; Hardidge, A; Findakly, D; Aminian, P; Elliott, R A

2017-10-01

Overprescribing of oxycodone is a contributor to the epidemic of prescription opioid misuse and deaths. Practice models to optimize oxycodone prescribing and supply need to be evaluated. We explored the impact of pharmacist-assisted discharge prescribing and medication review on oxycodone prescribing and supply for patients discharged from surgical wards. A retrospective audit was conducted on two surgical inpatient wards following a 16-week prospective pre- and post-intervention study. During the pre-intervention period, discharge prescriptions were prepared by hospital doctors and then reviewed by a ward pharmacist (WP) before being dispensed. Post-intervention, prescriptions were prepared by a project pharmacist in consultation with hospital doctors and then reviewed by a WP and dispensed. Proportion of patients who were prescribed, and proportion supplied, oxycodone on discharge; Median amount (milligrams) of oxycodone prescribed and supplied, for patients who were prescribed and supplied at least one oxycodone-containing preparation, respectively. A total of 320 and 341 patients were evaluated pre- and post-intervention, respectively. Pre-intervention, 75.6% of patients were prescribed oxycodone; after WP review, 60.3% were supplied oxycodone (Psupplied was 100 milligrams/patient. Post-intervention, 68.6% of patients were prescribed oxycodone; after WP review, 57.8% were supplied oxycodone (Psupplied was 50 milligrams/patient (difference in amount prescribed and supplied: 50 milligrams, Psupplied oxycodone but not the amount supplied/patient. Having a pharmacist assist with prescribing reduced the amount of oxycodone supplied. © 2017 John Wiley & Sons Ltd.

Nurse prescribing in general practice: a qualitative study of job satisfaction and work-related stress.

Science.gov (United States)

Cousins, Rosanna; Donnell, Christine

2012-04-01

Studies examining the impact nurse prescribing have largely focused on the efficacy of the service. It was suggested in pro-prescribing policy arguments that extending the nursing role to include prescribing would increase job satisfaction. This assertion has not been fully explored. To investigate the impact of independent prescribing for experienced nurse practitioners (NPs) working in general practice. In-depth interviews were conducted with six NPs who each had at least 3 years experience of independent prescribing in a busy inner city general practice. Analysis of interview data yielded two main themes: as independent prescribers NPs experienced increased levels of both job satisfaction and work-related stress. Increased satisfaction was associated with having greater autonomy and being able to provide more holistic care. Increased work-related stress emerged from greater job demands, perceived insufficient support and perceived effort-reward imbalance that centred upon the enhanced role not being recognized in terms of an increase in grade and pay. Independent prescribing increases job satisfaction for NPs in general practice, but there is also evidence of stressors associated with the role. It is important that NPs in general practice are encouraged and supported towards providing the effective patient-centred care in the community envisaged by current UK government. We acknowledge that the results presented in this paper are based on a sample limited to one city; however, it provides information that has important implications for the well being of NPs and ultimately patient care.

Biopolítica e Desenvolvimento? Foucault e Agamben sobre Estado, Governo e Violência

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Guilherme F. W. Radomsky

2015-06-01

Full Text Available Este artigo analisa as relações entre biopolítica e desenvolvimento sob o ângulo das noções de Estado, governo e violência. O objetivo consiste em examinar elementos analíticos que gravitam em torno de perspectivas críticas do desenvolvimento buscando um eixo interpretativo sobre a ambivalência das ações do Estado a partir de duas possibilidades teóricas que convergem no pensamento de Giorgio Agamben: a análise do biopoder e do governo em Foucault e as articulações entre violência e lei que remetem a Walter Benjamin. A reflexão sobre os argumentos teóricos é realizada examinando-se dados oriundos de pesquisa de abordagem qualitativa sobre políticas para a agricultura ecológica no sul do Brasil. As conclusões mostram que o desenvolvimento e seus benefícios podem ser problematizados pelo olhar do biopoder e da violência, que reconfiguram o que seja desenvolvimento, menos como expansão do bem-estar e mais como impulso modernizante de mudança que se ampara em administrar a vida.

Prescribing antibiotics to pediatric dengue: increasing risk of bacterial resistance

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Dhanunjaya Sandopa

2018-03-01

Full Text Available Background Use of antibiotics to treat self-limiting viral infections like dengue fever (DF without any co-morbid conditions in pediatric patients is common practice in India, and a major contribution of the inappropriate use of antibiotics in the country. Objective To provide an analysis of diagnosis, grading, and prescribing of antibiotics in pediatric inpatients with DF in a tertiary care teaching hospital in India. Methods Data from case sheets of all pediatric inpatients (n=370 diagnosed with DF without co-morbid conditions were collected with regards to diagnosis, grading, presence, and appropriateness of antibiotic usage according to the 2009 WHO Guidelines, the National Vector Borne Disease Control Program (NVBDCP of India Guidelines, and the Hospital Infection Society (HIS Guidelines. Results Platelet count determination (50% of the cases was the major diagnostic method for dengue. Inappropriate grading of DF was seen in 20% of patients. Almost 75% of the 370 dengue cases were prescribed antibiotics for the expressed purpose of avoiding hospital-acquired infections. A single antibiotic was given in 225 cases (60.81%, 2 antibiotics in 33 (8.91 % cases, and 3 antibiotics in 9 (2.43% cases. Conclusions From the results it is clear that antibiotics were prescribed to treat DF where the antibiotics do not have any role. DF is a self-limiting viral infection that can be treated with proper management of hemodynamic status with IV fluids. To avoid the usage of antibiotics in the treatment of dengue, awareness has to be created in healthcare professionals regarding the treatment guidelines for dengue and appropriate use of antibiotics to avoid hospital acquired infections.

Estudo longitudinal do desenvolvimento da comunicação em diversas economias mundiais.

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Emílio José Montero Arruda Filho

2012-08-01

Full Text Available O desenvolvimento do setor de comunicação de um país possui relações com o seu desenvolvimento econômico e é possível demonstrar essa conexão estatisticamente, como tem sido feito por pesquisadores de instituições como a ITU (International Telecommunications Union. Como esses dados estão apenas apresentados na forma simples e não levam em conta fatores de interconexão, é importante desenvolver pesquisas que avaliem a conexão entre variáveis relevantes no campo. Este trabalho visa analisar os fatores de desenvolvimento tecnológico de comunicação que melhor descrevem o posicionamento econômico de um país, integrando a usabilidade dos serviços de comunicação com o status econômico. Foram utilizados dados de 56 países, escolhidos aleatoriamente. Uma pesquisa na forma de datamining foi realizada, a qual analisou os dados existentes já previamente coletados por instituições de pesquisa tais como ITU, World Bank, e outras. Cada fator de usabilidade, preferência e serviço analisado é apontado como um reflexo de outros serviços e usos anteriormente desenvolvidos. Parte da literatura sobre esse tópico (ARRUDA FILHO; CASSIA; MARINO, 2008; CHERRY, 2007; DAVIES; HARDT; KELLY, 2004 argument que o desenvolvimento econômico de certos países existe como resultado de um aumento do desenvolvimento tecnológico, porém outras demonstram ou informam o contrário. Este artigo apresenta essas relações em certos países, escolhidos pela quantidade de informação disponível considerando sua posição de desenvolvimento global, relacionando diretamente o comportamento de crescimento ou redução no uso das tecnologias, tais como telefone e internet. Este trabalho coletou dados de duas fontes mundiais de informação dos setores mencionados: a International Telecommunications Union (ITU e o World Bank. Utilizaram-se as técnicas estatísticas de regressão e análise de variância para a análise de dados de 56 países ao longo de

Influences on the prescribing of new drugs.

Science.gov (United States)

Tobin, Luke; de Almedia Neto, Abelio C; Wutzke, Sonia; Patterson, Craig; Mackson, Judith; Weekes, Lynn; Williamson, Margaret

2008-01-01

The aim of this study was to identify the factors that influence prescribing of new drugs among general practitioners, endocrinologists and psychiatrists. Four focus groups were conducted with GPs, endocrinologists and psychiatrists on sources of awareness and influences on prescribing of new drugs. Pharmaceutical companies were the most important source for becoming aware of new drugs. There were many influences on the decision to prescribe a new drug, the most important being efficacy, safety, cost and advantage over existing therapies. Endocrinologists placed greater emphasis on evidence from clinical trials and scientific conferences, and psychiatrists and GPs placed more weight on pharmaceutical representatives, colleagues and specialists. New drug prescribing occurs in a complex environment with many influences. Effective interventions to promote rational, safe and effective prescribing of new drugs will need to be cognisant of these factors.

Facilitators and barriers of implementing and delivering social prescribing services: a systematic review.

Science.gov (United States)

Pescheny, Julia Vera; Pappas, Yannis; Randhawa, Gurch

2018-02-07

Social Prescribing is a service in primary care that involves the referral of patients with non-clinical needs to local services and activities provided by the third sector (community, voluntary, and social enterprise sector). Social Prescribing aims to promote partnership working between the health and the social sector to address the wider determinants of health. To date, there is a weak evidence base for Social Prescribing services. The objective of the review was to identify factors that facilitate and hinder the implementation and delivery of SP services based in general practice involving a navigator. We searched eleven databases, the grey literature, and the reference lists of relevant studies to identify the barriers and facilitators to the implementation and delivery of Social Prescribing services in June and July 2016. Searches were limited to literature written in English. No date restrictions were applied. Findings were synthesised narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. Eight studies were included in the review. The synthesis identified a range of factors that facilitate and hinder the implementation and delivery of SP services. Facilitators and barriers were related to: the implementation approach, legal agreements, leadership, management and organisation, staff turnover, staff engagement, relationships and communication between partners and stakeholders, characteristics of general practices, and the local infrastructure. The quality of most included studies was poor and the review identified a lack of published literature on factors that facilitate and hinder the implementation and delivery of Social Prescribing services. The review identified a range of factors that facilitate and hinder the implementation and delivery of Social Prescribing services. Findings of this review provide an insight for commissioners, managers, and providers

Antibiotic prescribing in dental practice in Belgium.

Science.gov (United States)

Mainjot, A; D'Hoore, W; Vanheusden, A; Van Nieuwenhuysen, J-P

2009-12-01

To assess the types and frequency of antibiotic prescriptions by Belgian dentists, the indications for antibiotic prescription, and dentists' knowledge about recommended practice in antibiotic use. In this cross-sectional survey, dental practitioners were asked to record information about all antibiotics prescribed to their patients during a 2-week period. The dental practitioners were also asked to complete a self-administered questionnaire regarding demographic data, prescribing practices, and knowledge about antibiotic use. A random sample of 268 Belgian dentists participated in the survey. During the 2-week period, 24 421 patient encounters were recorded; 1033 patients were prescribed an antibiotic (4.2%). The median number of prescriptions per dentist for the 2 weeks was 3. Broad spectrum antibiotics were most commonly prescribed: 82% of all prescriptions were for amoxycillin, amoxycillin-clavulanic acid and clindamycin. Antibiotics were often prescribed in the absence of fever (92.2%) and without any local treatment (54.2%). The most frequent diagnosis for which antibiotics were prescribed was periapical abscess (51.9%). Antibiotics were prescribed to 63.3% of patients with periapical abscess and 4.3% of patients with pulpitis. Patterns of prescriptions were confirmed by the data from the self-reported practice. Discrepancies between observed and recommended practice support the need for educational initiatives to promote rational use of antibiotics in dentistry in Belgium.

TECNOLOGIAS DIGITAIS: PROMOVENDO O DESENVOLVIMENTO SUSTENTÁVEL PARA O JOVEM DO CAMPO

OpenAIRE

Zarpelon, Mirian Cátia; Kolcenti, Cassiane; Balestrin, Deisi; Tortelli, Luana; Blazszack, Vinicíus; Guedes, Anibal Lopes

2015-01-01

O desenvolvimento sustentável é hoje em dia, um dos principais desafios a ser enfrentado na atualidade. Inclui-se neste universo a agricultura, através da consolidação das atividades produtivas a fim de desenvolver de forma sustentável, a gestão da propriedade rural, bem como sua condição ambiental e social, sem degradar o capital natural e mantendo o bem estar da sociedade. Dentro desse processo, as novas tecnologias proporcionam o desenvolvimento de soluções criativas simples que visam melh...

Economia e Desenvolvimento Social: A Possibilidade da Utilização de Indicadores Sociais na Avaliação do Desenvolvimento Paranaense

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Daniel Vitor Vicente

2013-12-01

Full Text Available Este trabalho pretende analisar a progressão de indicadores sociais no Paraná a partir dos anos 1990, utilizando como base de dados os indicadores sociais de Educação, Emprego e Renda, Saúde e Saneamento, disponibilizados pelo Instituto Paranaense de Desenvolvimento Econômico e Social - IPARDES. Para o desdobramento de tal reflexão, será resgatado brevemente o desenvolvimento econômico Brasileiro, cujo projeto de Estado está embasado no que se conhece por novo desenvolvimentismo. Do mesmo modo, também será abordada a possibilidade de serem utilizados indicadores sociais públicos e gratuitos, a fim de que os mesmos auxiliem nos procedimentos de análise e problematização de questões sociais que interessam às Ciências Sociais, utilizando-se como exemplo os dados que serão apresentados.

A study of antibiotic prescribing

DEFF Research Database (Denmark)

Jaruseviciene, L.; Radzeviciene-Jurgute, R.; Jurgutis, A.

2012-01-01

Background. Globally, general practitioners (GPs) write more than 90% of all antibiotic prescriptions. This study examines the experiences of Lithuanian and Russian GPs in antibiotic prescription for upper respiratory tract infections, including their perceptions of when it is not indicated...... clinically or pharmacologically. Methods. 22 Lithuanian and 29 Russian GPs participated in five focus group discussions. Thematic analysis was used to analyse the data. Results. We identified four main thematic categories: patients' faith in antibiotics as medication for upper respiratory tract infections......; patient potential to influence a GP's decision to prescribe antibiotics for upper respiratory tract infections; impediments perceived by GPs in advocating clinically grounded antibiotic prescribing with their patients, and strategies applied in physician-patient negotiation about antibiotic prescribing...

Prescribing procrastination

Science.gov (United States)

Thomson, George H.

1979-01-01

In his everyday work the family physician sees many patients whose problems have been diagnosed but for whom postponement of an active treatment plan is indicated. The physician must therefore prescribe procrastination in a carefully planned way. I describe some ideas and practical methods for doing this. PMID:529244

Antibiotic prescribing and patient satisfaction in primary care in England: cross-sectional analysis of national patient survey data and prescribing data.

Science.gov (United States)

Ashworth, Mark; White, Patrick; Jongsma, Hannah; Schofield, Peter; Armstrong, David

2016-01-01

Concerns about adverse effects on patient satisfaction may be an important obstacle to attempts to curtail antibiotic prescribing. To determine the relationship between antibiotic prescribing in general practice and reported patient satisfaction. Retrospective cross-sectional study of general practices in England. Data were obtained from the General Practice Patient Survey (GPPS) in 2012 (2.7 million questionnaires in England; 982 999 responses; response rate 36%); the national Quality and Outcomes Framework dataset for England, 2011-2012 (8164 general practices); and general practice and demographic characteristics. Standardised measures of antibiotic prescribing volumes were obtained for each practice in England during 2012-2013, together with 12 other nationally available prescribing variables. The role of antibiotic prescribing volume was identified as a determinant of GPPS scores and adjusted for demographic and practice factors using multiple linear regression. The final dataset consisted of 7800 (95.5%) practices. A total of 33.7 million antibiotic prescriptions were issued to a registered population of 53.8 million patients. Antibiotic prescribing volume was a significant positive predictor of all 'doctor satisfaction' and 'practice satisfaction' scores in the GPPS, and was the strongest predictor of overall satisfaction out of 13 prescribing variables. A theoretical 25% reduction in antibiotic prescribing volume would be associated with 0.5-1.0% lower patient satisfaction scores, a drop of 3-6 centile points in national satisfaction ranking. Patients were less satisfied in practices with frugal antibiotic prescribing. A cautious approach to antibiotic prescribing may require a trade-off in terms of patient satisfaction. © British Journal of General Practice 2016.

ATIVIDADES CORPORAIS AQUÁTICAS EM ESPECIAL O MERGULHO E O DESENVOLVIMENTO DO PSIQUISMO

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Celi Taffarel

2015-04-01

Full Text Available O presente estudo situa-se entre os que investigam o desenvolvimento do psiquismo ressaltando o papel da educação escolar e o acesso ao conhecimento clássico sobre as atividades corporais aquáticas, e dentre elas o mergulho, no desenvolvimento dos processos funcionais, através do ensino e da aprendizagem de conteúdos nucleares na escola. Objetivo:Analisar o desenvolvimento do psiquismo à luz da psicologia histórico-cultural e propor o trato com o conhecimento clássico sobre atividades aquáticas, em especial o mergulho, a luz da pedagogia histórico-critica, defendendo este conhecimento como nuclear no currículo escolar, nos estudos sobre a relação “ser humano-água”, para a elevação da capacidade teórica dos estudantes, através da metodologia do ensino critico-suparadora.

A taxa de câmbio no centro da teoria do desenvolvimento

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Luiz Carlos Bresser-Pereira

2012-08-01

Full Text Available Este artigo apresenta as principais ideias da macroeconomia estruturalista do desenvolvimento - a teoria por trás de novo-desenvolvimentismo. Seu foco é a taxa de câmbio que é pela primeira vez colocada no centro da economia do desenvolvimento. A teoria econômica geralmente vê a taxa de câmbio como um problema de curto prazo a ser discutido na macroeconomia. A macroeconomia estruturalista do desenvolvimento mostra que há, nos países em desenvolvimento, a tendência à sobreapreciação cíclica da taxa de câmbio causada pela falta de neutralização da doença holandesa e por entradas de capital excessivas. Em consequência, considera a taxa de câmbio cronicamente sobreapreciada e, por isso, um grande obstáculo ao crescimento econômico. No processo de desenvolvimento, a taxa de câmbio tem a função de um interruptor de luz que conecta ou desconecta as empresas nacionais que utilizam a tecnologia no estado da arte mundial dos mercados mundiais.This paper presents the main ideas of structuralist development macroeconomics - the theory behind new developmentalism. Its focus is on the exchange rate that is positioned for the first time in the core of development economics. Economic theory usually views the exchange rate as a short term problem to be discussed in open macroeconomics. Structuralist development macroeconomics argues that there is in developing countries a tendency to the cyclical overvaluation of the exchange rate caused by the lack of neutralization of the Dutch disease and by excessive capital inflows. In consequence it views the exchange rate as chronically overvalued, and, for that reason, a major obstacle to economic growth. In the development process, the exchange rate has the role of light switch that connects or disconnects the national business enterprises utilizing technology in the world state of the art from world markets.

A Cooperação Triangular e as Transformações da Cooperação Internacional para o Desenvolvimento

OpenAIRE

Bruno Ayllón Pino

2013-01-01

Nas últimas décadas, a Cooperação Internacional para o Desenvolvimento (CID) tem experimentado modalidades alternativas de execução, integrando países desenvolvidos, países em desenvolvimento e organismos multilaterais em formatos triangulares. Em um contexto de crise econômica, as limitações da CID para promover o desenvolvimento, somadas às dúvidas sobre o cumprimento dos compromissos financeiros dos doadores da Organização para a Cooperação e Desenvolvimento Econômico (OCDE), propiciaram o...

Desenvolvimento inicial de mudas de Butia odorata (Barb. Rodr. Noblick cultivadas em recipientes

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Claudimar Sidnei Fior

2014-10-01

Full Text Available Butia odorata (Barb.Rodr. Noblick (butiazeiro é uma palmeira nativa do sul do Brasil, com grande demanda para usos ornamental e agroindustrial. O objetivo deste estudo foi avaliar o desenvolvimento inicial de mudas de butiazeiro, em recipientes com diferentes composições de substratos. O experimento foi desenvolvido em casa de vegetação sem controle de temperatura e umidade. Foram utilizadas mudas com 60 dias após a germinação, e avaliados os substratos, em cinco proporções, dos componentes casca de arroz carbonizada e casca de pinus. Em etapa posterior, monitorou-se o efeito do pH do substrato no desenvolvimento das mudas mantidas nos mesmos recipientes e tratamentos. Para tanto, as plantas foram distribuídas em igual número e representação dos tratamentos, em quatro grupos, com quatro níveis de pH do substrato (4,0; 4,9; 5,8 e 6,7. Noventa dias após o início da primeira etapa, e 161 dias após o início da segunda, foram avaliados o desenvolvimento das plantas, a condutividade elétrica e o pH dos substratos. Na primeira etapa, constatou-se diferença entre os tratamentos somente para altura das plantas e pH do substrato, ambas relacionadas diretamente com a proporção de casca de pinus na formulação. Na segunda etapa, a composição do substrato foi determinante para o maior desenvolvimento das mudas. Somente o número de folhas não apresentou diferença significativa entre os tratamentos. Contudo, para todas as variáveis, a presença de casca de pinus, mesmo em baixa proporção, foi suficiente para favorecer o desenvolvimento vegetativo.

Designing magnets with prescribed magnetic fields

International Nuclear Information System (INIS)

Liu Liping

2011-01-01

We present a novel design method capable of finding the magnetization densities that generate prescribed magnetic fields. The method is based on the solution to a simple variational inequality and the resulting designs have simple piecewise-constant magnetization densities. By this method, we obtain new designs of magnets that generate commonly used magnetic fields: uniform magnetic fields, self-shielding fields, quadrupole fields and sextupole fields. Further, it is worth noting that this method is not limited to the presented examples, and in particular, three-dimensional designs can be constructed in a similar manner. In conclusion, this novel design method is anticipated to have broad applications where specific magnetic fields are important for the performance of the devices.

Charles Darwin: um observador do desenvolvimento humano

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Eloisa Helena Rubello Valler Celeri

2010-12-01

Full Text Available Os autores traduzem, pela primeira vez para o português, o artigo de Charles Darwin "A Biographical Sketch of an Infant", publicado no periódico Mind em julho de 1877. Utilizando anotações de observações do desenvolvimento de seus filhos, especialmente de seu filho mais velho William Erasmus (Doddy, Darwin descreve e estuda, a partir de seu enfoque naturalista, o filhote humano, narrando os primeiros indicativos comportamentais de emoções tais como raiva e medo, curiosidade e senso moral, o brincar e o prazer envolvido nesta atividade, a capacidade de imitação e os primeiros indícios daquilo que hoje conhecemos como "teoria da mente". Colocando-se questões sobre as capacidades do bebê, como eles aprendem e como se comunicam e levantando hipóteses sobre possíveis significados de certos comportamentos, questões ainda hoje fundamentais para o estudo do desenvolvimento humano, Darwin mostra-se também um pioneiro no estudo do bebê e da criança pequena, numa época na qual as capacidades dos bebês eram extremamente subestimadas e desconsideradas.

Antiepileptic drug prescribing before, during and after pregnancy

DEFF Research Database (Denmark)

Charlton, Rachel; Garne, Ester; Wang, Hao

2015-01-01

and after pregnancy were identified in each of the databases. AED prescribing patterns were analysed, and the choice of AEDs and co-prescribing of folic acid were evaluated. Results In total, 978 957 women with 1 248 713 deliveries were identified. In all regions, AED prescribing declined during pregnancy...... co-prescribed with high-dose folic acid: ranging from 1.0% (CI950.3–1.8%) in Emilia Romagna to 33.5% (CI9528.7–38.4%) in Wales. Conclusion The country's differences in prescribing patterns may suggest different use, knowledge or interpretation of the scientific evidence base. The low co......-prescribing of folic acid indicates that more needs to be done to better inform clinicians and women of childbearing age taking AEDs about the need to offer and receive complete preconception care....

O Estado (de Bem-Estar Social como Ator do Desenvolvimento: Uma História das Ideias

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Celia Lessa Kerstenetzky

2015-09-01

Full Text Available Reconstruímos neste artigo uma história das ideias, abstratas ou incorporadas em práticas concretas, da ação estatal voltada ao desenvolvimento, da concepção de "Estados-poder" a "Estados de Bem-Estar", seguindo o fluxo e o refluxo de argumentos em favor da intervenção. Justificativas de intervenção baseadas na necessidade de superar descontinuidades econômicas são contrapostas a argumentos que apontam os riscos e antídotos da captura do Estado por interesses privados, bem como à abordagem mais ampla ao desenvolvimento de Amartya Sen. Experiências nacionais de desenvolvimento e de Estado de Bem-Estar Social são também rastreadas, como "ideias incorporadas". Identificamos uma defesa da intervenção do Estado que integra os campos econômico, político e social e aponta a democracia e o Estado de Bem-Estar como temas emergentes no discurso do desenvolvimento.

Resiliência e Justiça Organizacional como Antecedentes da Percepção de Desenvolvimento Profissional

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Ana Claudia Monteiro

Full Text Available RESUMO O mercado competitivo da atualidade tem exigido mais qualificação dos trabalhadores, o que aumenta a relevância do construto desenvolvimento profissional. O objetivo deste estudo foi testar um modelo de predição da percepção do desenvolvimento profissional. Participaram da pesquisa 320 trabalhadores de diferentes categorias profissionais de organizações públicas e privadas. O questionário continha três escalas, todas com bons indicadores psicométricos. Os resultados apontados a partir da regressão múltipla confirmaram que percepção de justiça organizacional e resiliência predizem positivamente a percepção de desenvolvimento profissional, sendo que esta demonstra maior poder preditivo. Os resultados foram discutidos de acordo com a teoria do desenvolvimento profissional.

Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature.

Science.gov (United States)

Kroezen, Marieke; van Dijk, Liset; Groenewegen, Peter P; Francke, Anneke L

2011-05-27

A growing number of countries are introducing some form of nurse prescribing. However, international reviews concerning nurse prescribing are scarce and lack a systematic and theoretical approach. The aim of this review was twofold: firstly, to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; secondly, to identify possible mechanisms underlying the introduction and organisation of nurse prescribing on the basis of Abbott's theory on the division of professional labor. A comprehensive search of six literature databases and seven websites was performed without any limitation as to date of publication, language or country. Additionally, experts in the field of nurse prescribing were consulted. A three stage inclusion process, consisting of initial sifting, more detailed selection and checking full-text publications, was performed independently by pairs of reviewers. Data were synthesized using narrative and tabular methods. One hundred and twenty-four publications met the inclusion criteria. So far, seven Western European and Anglo-Saxon countries have implemented nurse prescribing of medicines, viz., Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA. The Netherlands and Spain are in the process of introducing nurse prescribing. A diversity of external and internal forces has led to the introduction of nurse prescribing internationally. The legal, educational and organizational conditions under which nurses prescribe medicines vary considerably between countries; from situations where nurses prescribe independently to situations in which prescribing by nurses is only allowed under strict conditions and supervision of physicians. Differences between countries are reflected in the jurisdictional settlements between the nursing and medical professions concerning prescribing. In some

Mesorregião Grande Fronteira do Mercosul: perfil locacional do desenvolvimento regional

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Jandir Ferrera de Lima

2010-05-01

Full Text Available O objetivo deste artigo é analisar o perfil das desigualdades regionais na área de abrangência na região Grande Fronteira do Mercosul (GFM, através da mensuração do coeficiente de desenvolvimento regional e do padrão de localização do emprego formal. No âmbito dessa análise ficaram demonstrados dois fenômenos espaciais: um processo de reestruturação espacial e a forte desigualdade das mesorregiões Sudoeste PR, Noroeste RS e Fronteira Oeste RS em relação às outras mesorregiões do Sul do Brasil. Esse resultado fortalece a identificação de particularidades espaciais capazes de esclarecer um padrão de desenvolvimento econômico regional diferenciado nas fronteiras, em particular na Região Sul do Brasil. Os resultados deste estudo forneceram elementos para a intervenção regional, pois é possível, via políticas públicas adequadas, buscar a retomada do dinamismo econômico e o desenvolvimento socioeconômico na GFM.

ELECTORAL PRESCRIBERS. WHO ARE THEY?

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Constantin SASU

2016-12-01

Full Text Available The decision to vote and choosing among the candidates is an extremely important one with repercussions on everyday life by determining, in global mode, its quality for the whole society. Therefore the whole process by which the voter decides becomes a central concern. Prescribers, supposed to have a big influence on the electoral market, are a component of the microenvironment political organizations. These are people who occupy important positions that can influence the behavior of others. In the political environment, prescribers are known under the name of "opinion formers", "opinion leaders", "mediators" (Beciu, 2009 or "influencers" (Keller and Berry, 2003 Weimann, 1994. This paper aims to review the central opinions on what is the influence prescribers, opinion makers on voting behavior, voting and decisions on whether and how they act?

Estilos parentais e personalidade: competências sociais e o desenvolvimento do processo resiliente

OpenAIRE

Ferreira, Sara Patrícia Duarte

2016-01-01

Dissertação de Mestrado em Psicologia Clínica De acordo com a literatura, as vivências afetivas e relacionais experienciadas no seio familiar, nomeadamente na relação entre pais-filhos, têm um papel privilegiado no desenvolvimento dos jovens. Nesta medida, postula-se que um estilo parental baseado na assertividade e responsividade assuma um papel significativo e protetor face ao desenvolvimento de características e competências adaptativas dos adolescentes e jovens adultos. A presente inve...

What Does ePrescribing Mean for Patients? A Case Study of the Perspectives of Hospital Renal Patients

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Lisa Lee

2015-11-01

Full Text Available BACKGROUND: Hospital ePrescribing systems are expected to improve quality of care for patients, yet the perspectives of patients themselves have seldom been explored in the context of ePrescribing deployments.OBJECTIVE: We sought to understand the significance of ePrescribing for patients through a case study of renal in-patients on a hospital ward, before and after the introduction of an ePrescribing system.METHODS: Three data sources were drawn on as part of the case study: interviews with representatives from national patient groups (n = 10, in-patients on a renal ward (n = 11 pre-implementation; n = 12 post-implementation and fieldnotes (n = 25 of observations made on the case study ward. Data were analysed thematically focusing on: (1 perceived benefits of ePrescribing; (2 patient awareness and understanding of the medications prescribed and (3 patient views on medicines reconciliation at admission and discharge.RESULTS: While ePrescribing was viewed positively overall, its implementation in the case study site failed to address the lack of patient involvement in the prescribing process and poor medication counselling upon discharge. Importantly, the limited impact of the ePrescribing system in these particular areas appeared to be the result of institutional and cultural practices rather than solely technological factors.CONCLUSIONS: The introduction of ePrescribing systems offers new opportunities to improve sharing of knowledge and communication with all those involved in the patient’s care pathways, including patients, carers and healthcare professionals across diverse care settings. Achieving this will, first and foremost, require significant cultural and policy shifts in how the patient’s role is perceived by clinicians in relation to medicines management.

Indução e desenvolvimento de calos e embriões somáticos em mamoeiro

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Almeida,Eliane Pires de; Oliveira,Roberto Pedroso de; Dantas,Jorge Luis Loyola

2001-01-01

Este trabalho teve por objetivo estabelecer um protocolo para a indução e desenvolvimento de calos e embriões somáticos em mamoeiro (Carica papaya L. cv. Tainung n.1). Foram utilizados quatro tipos de explantes (hipocótilo com folhas cotiledonares, hipocótilo, folhas cotiledonares e epicótilo) e duas condições de cultivo (escuro e 16 horas de luz). A indução e o desenvolvimento de calos foram avaliados nos meios de cultura ½MS2, ½MS10 e HMH e a indução e o desenvolvimento de embriões somático...

Planejamento no estado brasileiro: dificuldades estruturais para a concretização constitucional do desenvolvimento regional

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Rodrigo Soldi

2009-01-01

A dissertação visa identificar os entraves para a construção e a articulação do planejamento de desenvolvimento nacional e regional no contexto das atribuições da União, como ente chave na construção do federalismo cooperativo. Parte da investigação da distinção das expressões crescimento e desenvolvimento, para compreender a noção de desenvolvimento nacional, como um dos fundamentos da República Federativa do Brasil. Delineia a noção de planejamento, de plano econômico e sua relação com o di...

Perfil do desenvolvimento motor em escolares com excesso de peso

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Mayara Moura Alves da Cruz

2017-12-01

Full Text Available Introdução: Diferenças relacionadas ao peso e as habilidades motoras em crianças em idade escolar ainda apresentam controversias. Objetivo: Analisar a relação entre desenvolvimento motor e nível de atividade física com o índice de massa corporal (IMC de escolares com excesso de peso. Métodos: Foram avaliados 85 escolares de ambos os sexos, de 6 a 10 anos, de Presidente Prudente, São Paulo, Brasil. Os instrumentos utilizados foram a classificação do IMC/idade, a Escala de Desenvolvimento Motor e o Questionário do Nível de Atividade Física Modificado e Adaptado. A amostra foi dividida em dois grupos: grupo com excesso de peso (GEP, com 50 escolares com diagnostico nutricional de sobrepeso e obesidade; e grupo com normopeso (GNP, com 35 escolares eutroficos. Para analise dos dados obtidos foram utilizados: Shapiro Wilk (normalidade, teste t de Student não pareado ou Mann Whitney (amostras independentes, teste de Spearman (correlação e teste do χ2 (proporção, com nível de significância p<0,05. Resultados: O GEP apresentou resultados inferiores significantes no desenvolvimento motor geral (91,32±10,68 versus 97,14±9,06; p=0,010, nas áreas de motricidade fina – QM1 (93,21±21,59 versus 103,1±13,12; p=0,0138 e motricidade global – QM2 (90,31±23,54 versus 112,6±16,07; p<0,0001. Observou-se correlação positiva significativa entre o nível de atividade física e o desenvolvimento motor no GEP, nas áreas de equilibrio – QM3 (0,35080; p=0,0125 e organização espacial – QM5 (0,41820; p=0,0025. Conclusão: O GEP, quando comparado com o GNP, demonstrou resultados inferiores no quociente motor geral (QMG, QM1 e QM2.

O uso de múltiplas escalas geográficas no planejamento do desenvolvimento regional

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Vivian Costa Brito

2017-01-01

Full Text Available O uso de múltiplas escalas geográficas aplicadas ao planejamento de políticas públicas de desenvolvimento regional é recente no Brasil. Remete à criação da Política Nacional de Desenvolvimento Regional (PNDR em 2003. A ênfase dada na categoria socioespacial reflete uma abordagem de caráter territorialista, que se contrapõe ao planejamento com enfoque estritamente macrorregional e com viés econômico. Este artigo analisa a conformação de estruturação e implementação desse arranjo multiescalar, para compreender a dimensão do planejamento na PNDR I e II. Como eixo central de articulação da política tem-se a relação intergovernamental e extragovernamental com inserção de todos os setores, abarcando estratégias de ação multiescalares. A abordagem multiescalar precisa avançar sobre a questão do ritmo e direção do desenvolvimento. As ferramentas da transversalidade e da intersetorialidade devem refletir em mudança social. Sem isso, o desenvolvimento regional torna-se contraditório, longe de representar uma oportunidade para regiões deprimidas tanto econômica quanto socialmente.

The social act of electronic medication prescribing.

Science.gov (United States)

Aarts, Jos

2013-01-01

Prescribing medication is embedded in social norms and cultures. In modern Western health care professionals and policy makers have attempted to rationalize medicine by addressing cost-effectiveness of diagnostic and therapeutic treatments and the development of guidelines and protocols based on the outcomes of clinical studies. These notions of cost-effectiveness and evidence-based medicine have also been embedded in technology such as electronic prescribing systems. Such constraining systems may clash with the reality of clinical practice, where formal boundaries of responsibility and authorization are often blurred. Such systems may therefore even impede patient care. Medication is seen as the essence of medical practice. Prescribing is a social act. In a hospital medications may be aimed at treating a patient for a specific condition, in primary care the professional often meets the patient with her or his social and cultural notions of a health problem. The author argues that the design and implementation of electronic prescribing systems should address the social and cultural context of prescribing. Especially in primary care, where health problems are often ill defined and evidence-based medicine guidelines do not always work as intended, studies need to take into account the sociotechnical character of electronic prescribing systems.

Desenvolvimento e Sustentabilidade na América Latina: Velha História, Novos Caminhos

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Tayso Silva

2014-06-01

Full Text Available O desenvolvimento, considerado durante muito tempo um valor universalmente aceito, e meta de toda sociedade moderna, hoje é questionado, inclusive sobre a forma como é produzido. É demonstrada a importância do desenvolvimento sustentável em direção à conquista de melhores condições de vida. Determinou-se como objetivo principal deste estudo apresentar insights para a maximização da sustentabilidade enquanto dinamizadora da trajetória de desenvolvimento na América Latina. Foram considerados o Painel Intergovernamental sobre Mudanças Climáticas, a Organização das Nações Unidas, o Protocolo de Quioto, entre outros estudos de validade e aceitabilidade internacional para propor parâmetros estratégicos aos negócios da AL. DOI:10.5585/riae.v13i2.2095

The development and treatment of impulsivity = O desenvolvimento e tratamento da impulsividade

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Amorim Neto, Roque do Carmo

2011-01-01

Full Text Available Impulsividade é um fator presente em várias desordens psicológicas, incluindo ADHD, drogadição, comportamentos agressivos e automutiladores, e obesidade infantil. Impulsividade também é um fator de risco para o abandono de tratamento. Este artigo tem por objetivo apresentar as raízes da impulsividade do ponto de vista biológico, sociológico e do desenvolvimento humano, bem como as formas de tratamento mais comuns para pessoas com extrema impulsividade. Aqui também se inclui pesquisas das áreas de desenvolvimento neuronal e regulação emocional

Pharmaceutical policies: effects of financial incentives for prescribers.

Science.gov (United States)

Rashidian, Arash; Omidvari, Amir-Houshang; Vali, Yasaman; Sturm, Heidrun; Oxman, Andrew D

2015-08-04

policy on drug costs and healthcare utilisation have not been measured. Effects of the reimbursement rate reduction policy on drug use and drug costs are uncertain, as the certainty of such evidence has been assessed as very low. No included study assessed the effects of this policy on healthcare utilisation or health outcomes. Administration costs of the policies were not reported in any of the included studies. Although financial incentives are considered an important element in strategies to change prescribing patterns, limited evidence of their effects can be found. Effects of policies, including pay for performance policies, in improving quality of care and health outcomes remain uncertain. Because pharmaceutical policies have uncertain effects, and because they might cause harm as well as benefit, proper evaluation of these policies is needed. Future studies should consider the impact of these policies on health outcomes, drug use and overall healthcare expenditures, as well as on drug expenditures.

Prescribers and pharmaceutical representatives: why are we still meeting?

Science.gov (United States)

Fischer, Melissa A; Keough, Mary Ellen; Baril, Joann L; Saccoccio, Laura; Mazor, Kathleen M; Ladd, Elissa; Von Worley, Ann; Gurwitz, Jerry H

2009-07-01

Research suggests that pharmaceutical marketing influences prescribing and may cause cognitive dissonance for prescribers. This work has primarily been with physicians and physician-trainees. Questions remain regarding why prescribers continue to meet with pharmaceutical representatives (PRs). To describe the reasons that prescribers from various health professions continue to interact with PRs despite growing evidence of the influence of these interactions. Multi-disciplinary focus groups with 61 participants held in practice settings and at society meetings. Most prescribers participating in our focus groups believe that overall PR interactions are beneficial to patient care and practice health. They either trust the information from PRs or feel that they are equipped to evaluate it independently. Despite acknowledgement of study findings to the contrary, prescribers state that they are able to effectively manage PR interactions such that their own prescribing is not adversely impacted. Prescribers describe few specific strategies or policies for these interactions, and report that policies are not consistently implemented with all members of a clinic or institution. Some prescribers perceive an inherent contradiction between academic centers and national societies receiving money from pharmaceutical companies, and then recommending restriction at the level of the individual prescriber. Prescribers with different training backgrounds present a few novel reasons for these meetings. Despite evidence that PR detailing influences prescribing, providers from several health professions continue to believe that PR interactions improve patient care, and that they can adequately evaluate and filter information presented to them by PRs. Focus group comments suggest that cultural change is necessary to break the norms that exist in many settings. Applying policies consistently, considering non-physician members of the healthcare team, working with trainees, restructuring

Antibiotic Utilization and Prescribing Patterns in a Nigerian ...

African Journals Online (AJOL)

The study of prescribing pattern seeks to monitor, evaluate and suggest a modification in prescriber's prescribing habits so as to make medical care rational and cost effective. Information about antibiotic use pattern is necessary for a constructive approach to problems that arise from multiple antibiotics available. To identify ...

Investigações epidemiológicas sobre demência nos países em desenvolvimento

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M Scazufca

2002-12-01

Full Text Available Na medida em que a população mundial está envelhecendo, a demência está se constituindo em importante problema de saúde pública, particularmente nos países em desenvolvimento. Investigações epidemiológicas nestes países são escassas e apresentam dificuldades metodológicas adicionais, principalmente no que se refere à adequação sociocultural dos instrumentos utilizados para a definição de casos. Tendo em vista estas preocupações, foi fundado o "Grupo de Pesquisa em Demência 10/66", que é constituído por uma rede internacional de pesquisadores, predominantemente de países em desenvolvimento. O nome do grupo tem como referência o paradoxo de que menos de 10% dos estudos populacionais sobre demência são dirigidos aos 2/3 ou mais de casos de pessoas com demência que vivem em países em desenvolvimento. O objetivo do artigo é atualizar informações da literatura sobre as diferenças de prevalência e incidência de demência encontradas em países desenvolvidos e em desenvolvimento.

Investigações epidemiológicas sobre demência nos países em desenvolvimento

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Scazufca M

2002-01-01

Full Text Available Na medida em que a população mundial está envelhecendo, a demência está se constituindo em importante problema de saúde pública, particularmente nos países em desenvolvimento. Investigações epidemiológicas nestes países são escassas e apresentam dificuldades metodológicas adicionais, principalmente no que se refere à adequação sociocultural dos instrumentos utilizados para a definição de casos. Tendo em vista estas preocupações, foi fundado o "Grupo de Pesquisa em Demência 10/66", que é constituído por uma rede internacional de pesquisadores, predominantemente de países em desenvolvimento. O nome do grupo tem como referência o paradoxo de que menos de 10% dos estudos populacionais sobre demência são dirigidos aos 2/3 ou mais de casos de pessoas com demência que vivem em países em desenvolvimento. O objetivo do artigo é atualizar informações da literatura sobre as diferenças de prevalência e incidência de demência encontradas em países desenvolvidos e em desenvolvimento.

Occupational Exposure to Polycyclic Aromatic Hydrocarbon of Wildland Firefighters at Prescribed and Wildland Fires.

Science.gov (United States)

Navarro, Kathleen M; Cisneros, Ricardo; Noth, Elizabeth M; Balmes, John R; Hammond, S Katharine

2017-06-06

Wildland firefighters suppressing wildland fires or conducting prescribed fires work long shifts during which they are exposed to high levels of wood smoke with no respiratory protection. Polycyclic aromatic hydrocarbons (PAHs) are hazardous air pollutants formed during incomplete combustion. Exposure to PAHs was measured for 21 wildland firefighters suppressing two wildland fires and 4 wildland firefighters conducting prescribed burns in California. Personal air samples were actively collected using XAD4-coated quartz fiber filters and XAD2 sorbent tubes. Samples were analyzed for 17 individual PAHs through extraction with dichloromethane and gas chromatograph-mass spectrometer analysis. Naphthalene, retene, and phenanthrene were consistently the highest measured PAHs. PAH concentrations were higher at wildland fires compared to prescribed fires and were highest for firefighters during job tasks that involve the most direct contact with smoke near an actively burning wildland fire. Although concentrations did not exceed current occupational exposure limits, wildland firefighters are exposed to PAHs not only on the fire line at wildland fires, but also while working prescribed burns and while off-duty. Characterization of occupational exposures from wildland firefighting is important to understand better any potential long-term health effects.

Personal and professional challenges of nurse prescribing in Ireland.

Science.gov (United States)

McBrien, Barry

This article presents the challenges regarding the development of a collaborative practice agreement in order to undertake nurse prescribing in an emergency department in a large teaching hospital. Nurse prescribing has been introduced quite recently in Ireland. Although there is a plethora of knowledge regarding the topic, there are many personal and professional challenges in relation to this emerging role. The nurse prescribing initiative in Ireland is continually developing and many nurses now have the authority to prescribe from almost the same range of medicines as doctors. Prescribing has the potential to improve job satisfaction, autonomy and ultimately improves patient outcomes. However, nurses need to be cognisant of the impact it can have on the dynamics of the healthcare team. An analysis of some complexities of nurse prescribing is given, in conjunction with reflective thoughts on a clinical incident in the area of morphine prescribing.

O papel das Forças Armadas na I&D da Defesa como vector de desenvolvimento nacional

OpenAIRE

Simões, Luís

2010-01-01

A humanidade sempre se preocupou com o seu bem-estar, de alguma forma. Neste âmbito, o desenvolvimento económico tem vindo a desempenhar um papel fundamental. Após a revolução industrial, mas particularmente depois da II Guerra Mundial, os Estados têm-se preocupado com o respectivo desenvolvimento económico sustentável, entre outras questões, como garante de bem-estar das suas populações. A investigação e desenvolvimento (I&D), no seu conjunto, têm sido apontados como um possível vector de de...

Individualidade, conhecimento e linguagem na concepção dialética de desenvolvimento em Vigotski

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Newton Duarte

2016-01-01

Full Text Available Neste artigo são exploradas as relações, na psicologia vigotskiana, entre o indivíduo em desenvolvimento e as formas mais ricas de individualidade, de conhecimento e de linguagem. A proposição metodológica que Karl Marx apresenta em sua clássica análise do método da economia política, segundo a qual, a anatomia humana é uma chave para a anatomia do macaco, ou seja, a forma mais desenvolvida é uma referência para a compreensão da menos desenvolvida, é vista por Vigotski como força motora do desenvolvimento psíquico humano. Esse psicólogo defende que a relação com o adulto é necessária ao desenvolvimento da criança. Igualmente ele postula que a individualidade se desenvolve do “em si” ao “para si” e que os sistemas de instrumentos psicológicos mais ricos são indispensáveis ao alcance de níveis mais elevados de desenvolvimento psíquico.

Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis.

Science.gov (United States)

Anderson, Kristen; Stowasser, Danielle; Freeman, Christopher; Scott, Ian

2014-12-08

To synthesise qualitative studies that explore prescribers' perceived barriers and enablers to minimising potentially inappropriate medications (PIMs) chronically prescribed in adults. A qualitative systematic review was undertaken by searching PubMed, EMBASE, Scopus, PsycINFO, CINAHL and INFORMIT from inception to March 2014, combined with an extensive manual search of reference lists and related citations. A quality checklist was used to assess the transparency of the reporting of included studies and the potential for bias. Thematic synthesis identified common subthemes and descriptive themes across studies from which an analytical construct was developed. Study characteristics were examined to explain differences in findings. All healthcare settings. Medical and non-medical prescribers of medicines to adults. Prescribers' perspectives on factors which shape their behaviour towards continuing or discontinuing PIMs in adults. 21 studies were included; most explored primary care physicians' perspectives on managing older, community-based adults. Barriers and enablers to minimising PIMs emerged within four analytical themes: problem awareness; inertia secondary to lower perceived value proposition for ceasing versus continuing PIMs; self-efficacy in regard to personal ability to alter prescribing; and feasibility of altering prescribing in routine care environments given external constraints. The first three themes are intrinsic to the prescriber (eg, beliefs, attitudes, knowledge, skills, behaviour) and the fourth is extrinsic (eg, patient, work setting, health system and cultural factors). The PIMs examined and practice setting influenced the themes reported. A multitude of highly interdependent factors shape prescribers' behaviour towards continuing or discontinuing PIMs. A full understanding of prescriber barriers and enablers to changing prescribing behaviour is critical to the development of targeted interventions aimed at deprescribing PIMs and reducing the

Insulina e glicose como moduladores do desenvolvimento de plântulas de milho doce (Su1)

OpenAIRE

Oliveira Júnior, Luiz Fernando Ganassali; Bressan-Smith, Ricardo; Oliveira, Antônia Elenir Amâncio de; Pereira, Messias Gonzaga; Silva, Luciana Belarmindo; Viana, Leandro Hespanhol; Vieira, Henrique Duarte

2009-01-01

Durante a germinação e o desenvolvimento pós-germinativo de milho, o fluxo metabólico é intenso, ocorrendo síntese e degradação de açúcares (glicose, frutose e sacarose) e hidrólise de amido, além da redução da concentração do ácido abscísico (ABA). Acredita-se que altas concentrações de glicose exógena, promovam acúmulo de ABA, proporcionando atraso na germinação e desenvolvimento de plântulas. Concentrações menores, por outro lado, podem ocasionar estímulo na germinação e desenvolvimento. N...

Desenvolvimento regional sob o enfoque pós-keynesiano

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Júlia Elisabete Barden

2007-01-01

Full Text Available Este trabalho tem como objetivo fazer uma revisão bibliográfica acerca de estudosque analisam o desenvolvimento regional sob a perspectiva da teoria pós-keynesiana. Osresultados destes demonstram que o sistema financeiro, em especial os bancos,influenciam no grau de desenvolvimento das regiões, sobretudo, porque o comportamentodestes agentes segue um conceito importante utilizado pela teoria, a preferência pelaliquidez. Assim, a disponibilidade de crédito para investimento no sistema produtivosofrerá impactos importantes conforme a preferência pela liquidez dos bancos.Abstract This paper has as objective to bring a bibliographical review about the studies thatanalyze the regional development on the Post-Keynesian theory perspective. The resultsobtained show that the financial system especially the banks, however these agentsbehavior follow an important concept used by the theory, the preference to the liquidity.Yet, the credit responsibility for the investment in the productive system will sufferimportant impacts due to the preference for the liquidity from the banks.

An analysis and comparison of commonly available United Kingdom prescribing resources.

Science.gov (United States)

Cox, A R; Butt, T F; Ferner, R E

2010-08-01

Safe prescribing requires accurate and practical information about drugs. Our objective was to measure the utility of current sources of prescribing guidance when used to inform practical prescribing decisions, and to compare current sources of prescribing guidance in the UK with idealized prescribing guidance. We developed 25 clinical scenarios. Two independent assessors rated and ranked the performance of five common sources of prescribing guidance in the UK when used to answer the clinical scenarios. A third adjudicator facilitated review of any disparities. An idealized list of contents for prescribing guidance was developed and sent for comments to academics and users of prescribing guidance. Following consultation an operational check was used to assess compliance with the idealized criteria. The main outcome measures were relative utility in answering the clinical scenarios and compliance with the idealized prescribing guidance. Current sources of prescribing guidance used in the UK differ in their utility, when measured using clinical scenarios. The British National Formulary (BNF) and EMIS LV were the best performing sources in terms of both ranking [mean rank 1·24 and 2·20] and rating [%excellent or adequate 100% and 72%]. Current sources differed in the extent to which they fulfilled criteria for ideal prescribing guidance, but the BNF, and EMIS LV to a lesser extent, closely matched the criteria. We have demonstrated how clinical scenarios can be used to assess prescribing guidance resources. Producers of prescribing guidance documents should consider our idealized template. Prescribers require high-quality information to support their practice. Our test was helpful in distinguishing between prescribing resources. Producers of prescribing guidance should consider the utility of their products to end-users, particularly in those more complex areas where prescribers may need most support. Existing UK prescribing guidance resources differ in their

Pharmacy clients' attitudes to expanded pharmacist prescribing and the role of agency theory on involved stakeholders.

Science.gov (United States)

Hoti, Kreshnik; Hughes, Jeffery; Sunderland, Bruce

2011-02-01

To examine the views of regular pharmacy clients on pharmacist prescribing and employ agency theory in considering the relationship between the stakeholders involved. Computer assisted telephone interviews were conducted with 400 pharmacy clients recruited around Australia. Potential respondents were identified using a random number generation function in Microsoft Excel. Data were analysed with SPSS version 17 using one-way analysis of variance, principal component analysis and linear regression. The relationships between the main stakeholders involved were explored using agency theory. A total of 1153 answered calls recruited 400 consenting pharmacy clients. Most respondents (71%) trusted pharmacists adopting an expanded role in prescribing, however the majority (66%) supported this only after a diagnosis had been made by a doctor. Those who accepted pharmacist diagnosing and prescribing preferred that this was limited to pain management and antibiotics. Most respondents (64%) considered that expanded pharmacist prescribing would improve their access to prescription medicines, although those over 65 years of age were less supportive than younger respondents. Factors which contributed positively to clients' perception of trust in an expanded prescribing role for pharmacists were identified, and improved access to medicines was found to be the strongest predictor (P Agency theory would conceptualize the introduction of pharmacist prescribers, as disrupting the principal (patient) agent (doctor) relationship. Its introduction would best be facilitated by careful change management. © 2011 The Authors. IJPP © 2011 Royal Pharmaceutical Society.

Um metodo para modelagem de exceções em desenvolvimento baseado em componentes

OpenAIRE

Patrick Henrique da Silva Brito

2005-01-01

Resumo: Devido a grande popularização do Desenvolvimento Baseado em Componentes (DBC), ele vem sendo empregado inclusive no desenvolvimento de sistemas computacionais críticos. O emprego do DBC na construção de sistemas confiáveis evidencia a necessidade de se desenvolver componentes de software que sejam robustos e que possuam uma garantia maior do seu funcionamento correto. Tratamento de exceções é uma técnica bastante conhecida para a verificação e tratamento de erros em sistemas de softwa...

Avaliação da influência da temperatura sobre o desenvolvimento de Aedes albopictus

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Daniéla Cristina Calado

2002-04-01

Full Text Available OBJETIVO: Verificar a influência da temperatura sobre os estágios de desenvolvimento de Aedes albopictus sob condições de laboratório. MÉTODOS: Foi avaliado o período de desenvolvimento dos estágios de ovo, larva e pupa em quatro temperaturas constantes de 15ºC, 20ºC, 25ºC e 30ºC em câmaras climatizadas com umidade relativa do ar oscilando entre 70% e 85% e fotoperíodo de CE 12:12 horas. Pela análise de variância, foram testados os efeitos das quatro temperaturas constantes. RESULTADOS: O período de incubação dos ovos compreendeu 38,38; 19,09; 13,10; e 10,44 dias; o período larval dos indivíduos machos atingiu 30,13; 13,83; 7,36; e 5,57 dias; o período larval para fêmeas apresentou duração de 33,22; 15,00; 8,06; e 6,16 dias; o período pupal em machos compreendeu 8,01; 4,92; 2,40; e 1,76 dias, enquanto nas fêmeas foi de 8,15; 5,11; 2,60; e 1,88 dias sob as temperaturas de 15ºC, 20ºC, 25ºC e 30ºC, respectivamente. Em todos os estágios de desenvolvimento, foram encontradas diferenças significativas, entre as temperaturas avaliadas, em torno de 5% no tempo de desenvolvimento. O período de desenvolvimento foi inversamente relacionado à temperatura, com o período larval mais breve em machos que em fêmeas. Nas temperaturas de 20ºC a 30ºC, o desenvolvimento foi mais breve e com maior viabilidade que a 15ºC. CONCLUSÕES: Nas condições em que foram realizados os experimentos, a temperatura afetou de forma significativa e inversamente proporcional os estágios imaturos de Aedes albopictus. Esses resultados mostram que os estágios imaturos são mais suscetíveis durante os períodos de baixas temperaturas devido ao maior tempo necessário para completar o desenvolvimento, informação que pode ser utilizada em estratégias de controle.

Improving antimicrobial prescribing in Irish primary care through electronic data collection and surveillance: a feasibility study.

Science.gov (United States)

Galvin, Sandra; Callan, Aoife; Cormican, Martin; Duane, Sinead; Bennett, Kathleen; Murphy, Andrew W; Vellinga, Akke

2015-07-02

The increase in the spread of antimicrobial resistance (AMR) in bacterial pathogens and limited availability of new antimicrobials places immense pressure on general practitioners (GPs) to prescribe appropriately. Currently, electronic antimicrobial prescribing data is not routinely collected from GPs in Ireland for surveillance purposes to assess regional specific fluctuations or trends in antimicrobial prescribing. The current study aimed to address this issue by assessing the feasibility of remotely extracting antimicrobial prescribing data from primary care practices in Ireland, for the purpose of assessing prescribing quality using the European Surveillance of Antimicrobial Consumption (ESAC) drug specific quality indicators. Participating practices (n = 30) uploaded data to the Irish Primary Care Research Network (IPCRN). The IPCRN data extraction facility is integrated within the practice patient management software system and permitted the extraction of anonymised patient prescriptions for a one year period, from October 2012 to October 2013. The quality of antimicrobial prescribing was evaluated using the twelve ESAC drug specific quality indicators using the defined daily dose (DDD) per 1,000 inhabitants per day (DID) methodology. National and European prescribing surveillance data (based on total pharmacy sales) was obtained for a comparative analysis. Antimicrobial prescriptions (n = 57,079) for 27,043 patients were obtained from the thirty study practices for a one year period. On average, study practices prescribed a greater proportion of quinolones (37 % increase), in summer compared with winter months, a variation which was not observed in national and European data. In comparison with national data, study practices prescribed higher proportions of β-lactamase-sensitive penicillins (4.98 % vs. 4.3 %) and a greater use of broad spectrum compared to narrow-spectrum antimicrobials (ratio = 9.98 vs. 6.26) was observed. Study practices exceeded the

Desenvolvimento puberal em meninas tratadas de LLA

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Monteiro I.M.M.

1998-01-01

Full Text Available OBJETIVO: Com o objetivo de avaliar o desenvolvimento puberal após o tratamento de leucemia linfóide aguda (LLA na infância, foi realizado um estudo retrospectivo, em meninas tratadas de janeiro de 1980 a janeiro de 1991, no Centro de Investigações Hematológicas "Dr. Domingos A. Boldrini", em Campinas-SP. CASUÍSTICA E MÉTODO: Foram selecionadas 42 meninas, tratadas antes da puberdade com quimioterapia sistêmica e intratecal e radioterapia cranial, utilizando doses de 18 ou 24 Grays (Gy. RESULTADOS: As idades médias da telarca, pubarca e menarca foram inferiores às do grupo-controle, embora com significância estatística apenas para a idade da telarca. Não houve diferenças entre os grupos tratados com 18 ou 24Gy. As meninas tratadas antes dos cinco anos de idade apresentaram idade média da menarca estatisticamente inferior àquelas tratadas após cinco anos e em relação ao grupo-controle. CONCLUSÃO: Os resultados mostraram que o desenvolvimento puberal em meninas tratadas de LLA na infância foi mais precoce que o de meninas saudáveis.

Descrição do desenvolvimento neuropsicomotor e visual de crianças com deficiência visual

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Telma de Araujo Souza

2010-12-01

Full Text Available Objetivo: Avaliar o desenvolvimento neuropsicomotor e visual de crianças com deficiência visual. Métodos: Foram avaliadas 45 crianças, de ambos os gêneros, em um período de 6 meses. As crianças foram distribuidas em dois grupos de estudo: experimental e de controle. Dessa forma aplicou-se a avaliação do desenvolvimento neuropsicomotor e da funcionalidade visual. Resultado: No grupo controle 86,66% da amostra estava inadequado quanto ao comportamento da coordenação, entretanto, todos os aspectos analisados estavam inadequados. As diferenças entre os grupos mostraram-se significativas, já que valores como p<0,05 foram evidenciados, tanto no comportamento da funcionalidade visual, quanto no desenvolvimento neuropsicomotor. Conclusão: Na amostra estudada, observou-se que os deficientes visuais caracterizavam-se por apresentar atraso global, do desenvolvimento, principalmente no comportamento da coordenação.

Age-specific antibiotic prescribing and adherence to guidelines in pediatric patients in primary care.

NARCIS (Netherlands)

Ivanovska, V.; Hek, K.; Mantel-Teeuwisse, A.K.; Leufkens, H.G.M.; Dijk, L. van

2018-01-01

Background: Most antibiotics in children are used to treat viral and self-limiting conditions. This study aims to compare physicians' adherence to guidelines on antibiotic prescribing in fever and in ear and respiratory infections to children in different age groups in the Netherlands. Methods: Data

[Medication reconciliation errors according to patient risk and type of physician prescriber identified by prescribing tool used].

Science.gov (United States)

Bilbao Gómez-Martino, Cristina; Nieto Sánchez, Ángel; Fernández Pérez, Cristina; Borrego Hernando, Mª Isabel; Martín-Sánchez, Francisco Javier

2017-01-01

To study the frequency of medication reconciliation errors (MREs) in hospitalized patients and explore the profiles of patients at greater risk. To compare the rates of errors in prescriptions written by emergency physicians and ward physicians, who each used a different prescribing tool. Prospective cross-sectional study of a convenience sample of patients admitted to medical, geriatric, and oncology wards over a period of 6 months. A pharmacist undertook the medication reconciliation report, and data were analyzed for possible associations with risk factors or prescriber type (emergency vs ward physician). A total of 148 patients were studied. Emergency physicians had prescribed for 68 (45.9%) and ward physicians for 80 (54.1%). A total of 303 MREs were detected; 113 (76.4%) patients had at least 1 error. No statistically significant differences were found between prescriber types. Factors that conferred risk for a medication error were use polypharmacy (odds ratio [OR], 3.4; 95% CI, 1.2-9.0; P=.016) and multiple chronic conditions in patients under the age of 80 years (OR, 3.9; 95% CI, 1.1-14.7; P=.039). The incidence of MREs is high regardless of whether the prescriber is an emergency or ward physician. The patients who are most at risk are those taking several medications and those under the age of 80 years who have multiple chronic conditions.

OS MODELOS DE CRESCIMENTO E DE DESENVOLVIMENTO ECONÔMICO E SUA APLICABILIDADE NAS ECONOMIAS REGIONAIS NÃO DESENVOLVIDAS

OpenAIRE

Adelmo M. França

2012-01-01

Neste artigo serão apresentadas as definições de crescimento e desenvolvimento econômico e as algumas discussões propostas pelos principais modelos econômicos voltados ao crescimento e desenvolvimento econômicos, questionando o fato deles terem suas origens nas economias desenvolvidas e, portanto, distantes das realidades sociais, políticas e econômicas dos países e das regiões pobres ou em fase de desenvolvimento. As abordagens sobre o tema estarão focadas na realidade econômica brasileira d...

Growth of nurse prescribing competence: facilitators and barriers during education.

Science.gov (United States)

Hopia, Hanna; Karhunen, Anne; Heikkilä, Johanna

2017-10-01

To describe facilitators and barriers in relation to the growth of nurse prescribing competence from the perspective of the nurses studying in a prescribing programme. The number of nurses enrolled in a nurse prescribing programme is rapidly increasing in Finland. However, few studies on nurse prescribing education are available and therefore research is needed, particularly from the point of view of nurses studying in the programme. The descriptive, qualitative study used the text of student online learning diaries as data during a 14-month prescribing programme. The sample consisted of 31 nurses, public health nurses or midwives enrolled in a prescribing programme at a university of applied sciences. The data were analysed using the inductive analysis method. The growth of nurses' prescribing competence was facilitated by learning clinical examination of the patient, networking with peers, receiving support from the workplace and supervisors, doctors' positive attitude towards nurse prescribing and being able to apply competencies directly to nursing practice. The barriers to the growth of nurses' prescribing competence were unclear job description, incomplete care plans and concerns about how consultation with doctors will be organised and realised. The results show that, for the purpose of developing the new role and position of nurse prescribers, educators and nursing managers must invest more in staff awareness of nurse prescribing education and also offer more support to nurse prescribers in their workplaces. The results of this study can be used especially in countries where nurse prescribing education is only in the process of being planned or has just been started. Heads of nursing and educators in prescribing education will benefit from the results when creating expanded job descriptions for nurses and supporting networking between students during the period of training. © 2016 John Wiley & Sons Ltd.

"What they see is what you get": Prescribing antibiotics for respiratory tract infections in primary care: Do high prescribers diagnose differently? An analysis of German routine data.

Science.gov (United States)

Hueber, Susann; Kuehlein, Thomas; Gerlach, Roman; Tauscher, Martin; Schedlbauer, Angela

2017-01-01

Characteristics of high and low prescribers of antibiotics in German primary care were analysed using population data. We aimed to evaluate differences in prescribing rates and factors being associated with high prescribing, and whether high prescribers made the diagnosis of perceived bacterial infections more often. Routine data were provided by the Bavarian Association of Statutory Health Insurance Physicians. Routine data are delivered by primary care practices on a quarterly basis. We analysed data from 2011 and 2012. Patients older than 15 years with respiratory tract infections consulting a primary care physician were selected (6.647 primary care practices). Patient and physician characteristics associated with high prescribing were identified using stepwise logistic regression. Mean prescribing rate of antibiotics was 24.9%. Prescribing rate for high prescribers was 43.5% compared to 8.5% for low prescribers. High prescribers made the diagnosis of perceived bacterial infections more often (Mhigh = 64.5%, Mlow = 45.2%). In the adjusted regression model, perceived bacterial infections were strongly associated with high prescribing (OR = 13.9, 95% CI [10.2, 18.8]). Treating patients with comorbidities was associated with lower prescribing of antibiotics (OR = 0.6, 95% CI [0.4, 0.8]). High prescribers had a higher practice volume, a higher degree of prescribing dominance, and were situated more often in deprived areas and in rural settings. Compared to findings of studies in other European countries, prescribing rates were low. There was a considerable difference between prescribing rates of high and low prescribers. Diagnostic labelling was the best predictor for high prescribing. Current guidelines recommend considering antibiotic treatment for patients with co-morbidities. In our study, treating a large number of high-risk patients was not associated with high prescribing.

Out-Patient Prescribing Practices at Mbagathi District Hospital ...

African Journals Online (AJOL)

On average, each patient was prescribed 3.85 types of drugs. A total of 835 drugs were prescribed by generic name, accounting for 25.6% of total number of drugs prescribed (1,506). Out of 391 sampled prescriptions, 266 had antibiotics accounting for (68.0%). A relatively small proportion of the prescriptions, 9.5% had an ...

Assessment of antibiotic prescribing in Latvian general practitioners

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Dumpis Uga

2013-01-01

Full Text Available Abstract Background Though general antibiotic consumption data is available, information on the actual patterns of prescribing antibiotics locally is difficult to obtain. An easy to use methodology was designed to assess ambulatory management of infections by Latvian general practitioners (GPs. Methods GPs were asked to record data in a patient data collection form for every patient that received antibiotics. Study period – (7 days one week in November, 2008. Data recorded included the following details: an antibiotic, the prescribed dose, dosing interval, route of administration combined with the demographic factors of the patient and clinical diagnosis based on a pre-defined list. Results Two hundred forty eight forms out of the 600 (41% were returned by post. Antibiotics were prescribed in 6.4% (1711/26803 of outpatient consultations. In total, 1763 antibiotics were prescribed during the study period. Ninety seven percent of the patients received monotherapy and only 47 (2.7% patients were prescribed two antibiotics. The most commonly prescribed antibiotics were amoxicillin (33.9% of prescribed, amoxicillin/clavulanate (18,7% and clarithromycin (7.6%. The most commonly treated indications were pharyngitis (29.8%, acute bronchitis (25.3% and rhinosinusitis (10.2%. Pneumonia was mostly treated with amoxicillin/clavulanate (25,7%, amoxicillin (15.7% and clarithromycin (19.3%. Conclusions Methodology employed provided useful additional information on ambulatory practice of prescribing antibiotics and could be used in further assessment studies. Educational interventions should be focused on treatment of acute pharyngitis and bronchitis in children and unnecessary use of quinolones in adults for uncomplicated urinary tract infection.

48 CFR 352.231-70 - Salary rate limitation.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Salary rate limitation... Salary rate limitation. As prescribed in 331.101-70, the Contracting Officer shall insert the following clause: Salary Rate Limitation (January 2010) (a) Pursuant to the current and applicable prior HHS...

A influência da família no desenvolvimento da superdotação

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Paulo Vinícius Carvalho Silva

Full Text Available Vários estudos destacam a importância da família para a manifestação, desenvolvimento e reconhecimento da superdotação. O desenvolvimento de comportamentos de superdotação impõe novos desafios e demandas aos próprios indivíduos superdotados e seus familiares, que, em algumas ocasiões, não possuem o esclarecimento necessário para atendê-las. Sendo assim, o objetivo geral deste ensaio é sintetizar e analisar criticamente as investigações realizadas sobre a relação entre a família e o indivíduo superdotado nas áreas esportiva, musical, artística e acadêmica. Estas pesquisas indicam uma grande variedade de práticas parentais e características familiares associadas ao desenvolvimento de comportamentos de superdotação. A análise crítica dos artigos examinados poderá suscitar a realização de outras pesquisas sobre a participação da família no processo de desenvolvimento do talento. Além disso, os esclarecimentos deste ensaio poderão auxiliar a elaboração e implementação de programas de atendimento a indivíduos superdotados e suas respectivas famílias.

A qualitative study of GPs' and PCO stakeholders' views on the importance and influence of cost on prescribing.

Science.gov (United States)

Prosser, Helen; Walley, Tom

2005-03-01

With prescribing expenditure rising and evidence of prescribing costs variation, general practitioners (GPs) in the UK are under increasing pressure to contain spending. The introduction of cash-limited, unified budgets and increased monitoring of prescribing within Primary Care Organizations (PCO) are intended to increase efficiency and enhance GPs financial responsibility. Whilst GPs regularly receive data on the costs of their prescribing and also performance against a set prescribing budget, little is known about the extent to which GPs take cost into account in their prescribing decisions. This study undertook a qualitative exploration of the attitudes of various stakeholders on the relative importance and influence of cost on general practice prescribing. In order to explore a plurality of perspectives, data were obtained from focus groups and a series of individual semi-structured interviews with GPs and key PCO stakeholders. The data suggest that although almost all GPs believed costs should be taken into account when prescribing, there was great variation in the extent to which this was applied and to how sensitive GPs were to costs. Cost was secondary to clinical effectiveness and safety, whilst individual patient need was emphasized above other forms of rationality or notions of opportunity costs. Conflict was apparent between a PCO policy of cost-containment and GPs' resistance to cost-cutting. GPs largely applied simple cost-minimization while cost-consideration was undermined by contextual factors. Implications for research and policy are discussed.

Dutch Travel Health Nurses: Prepared to Prescribe?

NARCIS (Netherlands)

Overbosch, Femke W.; Koeman, Susan C.; van den Hoek, Anneke; Sonder, Gerard J. B.

2012-01-01

Background. In travel medicine, as in other specialties, independent prescribing of medication has traditionally been the domain of practitioners like physicians, dentists, and midwives. However, a 2011 ruling in the Netherlands expands independent prescribing and introduces supplementary

Considerações sobre o desenvolvimento de jogos por meio do framework Scrum

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Olívia Hamada

2016-02-01

Full Text Available Os jogos (games se configuram como a contemporânea maneira das pessoas se relacionarem com as soluções tecnológicas e com os aplicativos. As expansões nas vendas dos dispositivos, dos aplicativos e os números de usuários, ano a ano, aumentam em proporções interessantes em termos de negócios e de consolidação de tendências nos hábitos. Desta forma, o desenvolvimento rápido, eficaz e de qualidade para os jogos se torna essencial para as empresas e para os parceiros que participam das suas elaborações, comercialização, suporte e disseminação. Utilizam-se metodologias diversas para esse desenvolvimento, tendo as metodologias ágeis as maiores possibilidades de sucesso. Este artigo trata do desenvolvimento dos jogos, as metodologias aplicadas e, em particular, do framework Scrum. Conclui-se que o Scrum é efetivamente uma boa opção para a construção de jogos, em função de suas características próprias.

O desafio político do desenvolvimento sustentado The political challenge of sustainable development

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Roberto P. Guimarães

1995-01-01

Full Text Available A unanimidade que hoje parece haver em favor do desenvolvimento sustentado contrasta com a ausência de iniciativas políticas significativas para transformar as instituições econômicas, sociais e políticas que estão comprometidas com o estilo vigente de desenvolvimento. Em particular, há uma patente contradição entre o discurso antiestatista hegemônico e as exigências do desenvolvimento sustentado, que incluem um Estado ainda mais forte, em suas capacidades reguladoras e de planificação, que o Estado intervencionista do passado.The seeming unanimity in favour of sustainable development stands in contrast to the absence of meaningful political initiatives in order to change the economic, social and political intitutions linked to the ongoing style of development In particular there is a patent contradiction between the hegemonic antistatist discourse and the requirements for sustainable development, including a state with even more regulatory and planning powers than the interventionist state of the past.

South African medical students’ perceptions and knowledge about antibiotic resistance and appropriate prescribing: Are we providing adequate training to future prescribers?

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Sean Wasserman,

2017-05-01

Full Text Available Background. Education of medical students has been identified by the World Health Organization as an important aspect of antibiotic resistance (ABR containment. Surveys from high-income countries consistently reveal that medical students recognise the importance of antibiotic prescribing knowledge, but feel inadequately prepared and require more education on how to make antibiotic choices. The attitudes and knowledge of South African (SA medical students regarding ABR and antibiotic prescribing have never been evaluated. Objective. To evaluate SA medical students’ perceptions, attitudes and knowledge about antibiotic use and resistance, and the perceived quality of education relating to antibiotics and infection. Methods. This was a cross-sectional survey of final-year students at three medical schools, using a 26-item self-administered questionnaire. The questionnaires recorded basic demographic information, perceptions about antibiotic use and ABR, sources, quality, and usefulness of current education about antibiotic use, and questions to evaluate knowledge. Hard-copy surveys were administered during whole-class lectures. Results. A total of 289 of 567 (51% students completed the survey. Ninety-two percent agreed that antibiotics are overused and 87% agreed that resistance is a significant problem in SA – higher proportions than those who thought that antibiotic overuse (63% and resistance (61% are problems in the hospitals where they had worked (p<0.001. Most reported that they would appreciate more education on appropriate use of antibiotics (95%. Only 33% felt confident to prescribe antibiotics, with similar proportions across institutions. Overall, prescribing confidence was associated with the use of antibiotic prescribing guidelines (p=0.003, familiarity with antibiotic stewardship (p=0.012, and more frequent contact with infectious diseases specialists (p<0.001. There was an overall mean correct score of 50% on the knowledge

Saúde e territorialização na perspectiva do desenvolvimento Health and territorialization from the perpective of development

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Carlos Augusto Grabois Gadelha

2011-06-01

Full Text Available A relação entre saúde e desenvolvimento é complexa e remete ao campo da economia política, dado que envolve diferentes interesses sociais, políticos e econômicos. No caso brasileiro, esta associação é particularmente relevante no que diz respeito à dimensão territorial, tendo em vista o papel central dos serviços de saúde para organização da rede urbana e delimitação de escalas e limites territoriais. No campo teórico-conceitual, o artigo explora vertentes analíticas das relações entre saúde e desenvolvimento, bem como entre a saúde e a questão territorial. A seguir, analisa a trajetória da política de descentralização e regionalização do Sistema Único de Saúde (SUS e dos investimentos federais, que constituem a base de sua evolução espacial. A partir da revisão conceitual e dos dados empíricos, procuram-se estabelecer os nexos teóricos e político-institucionais entre saúde e desenvolvimento, buscando subsidiar a discussão dos desafios para uma nova inserção da saúde no modelo de desenvolvimento brasileiro, historicamente marcado por desigualdades econômicas e sociais com forte expressão territorial.The relationship between health and development is complex and lies in the field of political economy, given that it involves different social, political, and economic interests. In the Brazilian case, this association is particularly relevant in terms of the territorial dimension, in light of the central role of healthcare services in the organization of the urban network and the demarcation of territorial schedules and limits. In the theoretical-conceptual field, this study explores analytical areas that approach the relations between health and development, as well as between health and the territorial issue; and analyzes the history of the decentralization and regionalization policy in the Unified National Health System (SUS and Federal investments that constitute the basis for its spatial evolution

Prevalence and Predictors of Inappropriate Medications Prescribing ...

African Journals Online (AJOL)

Data analysis involved use of World Health Organization (WHO) prescribing indicators, Updated 2002 Beer's criteria and DRUG-REAX® system software package of MICROMEDEX (R) Healthcare Series to assess the prescribing pattern, identify potentially inappropriate medications and potential drug-drug interactions, ...

Health Canada Warning on Citalopram and Escitalopram--Its Effects on Prescribing in Consultation-Liaison Psychiatry.

Science.gov (United States)

Do, André; Noohi, Saeid; Elie, Dominique; Mahdanian, Artin A; Yu, Ching; Segal, Marilyn; Looper, Karl J; Rej, Soham

2016-01-01

Reports have suggested that citalopram and escitalopram may prolong the QTc interval, leading Health Canada to issue a warning to limit their dosages in 2012. Little is known about the effects of this warning and similar ones (e.g., by the Food and Drug Administration) on antidepressant prescribing in inpatients with acute medical illness, who are theoretically at high risk of QTc prolongation. The main objective of our study is to examine the effect of the Health Canada warning on citalopram/escitalopram prescribing patterns in the consultation-liaison (C-L) psychiatry setting. We performed a retrospective cohort study including 275 randomly selected inpatients with medical illness assessed by the psychiatric C-L team of a large Canadian academic hospital between 2008 and 2014. We grouped patients based on whether they were assessed by the C-L team before or after the citalopram Health Canada warning. Our primary outcome was change in citalopram/escitalopram prescribing patterns. We found that of patients seen before the Health Canada warning, a significantly higher number were prescribed citalopram/escitalopram (44.1% vs. 22.3%, χ(2) = 14.835, p Canada warning was similar in both groups (8.9% vs. 12.1%, χ(2) = 0.233, p = 0.63). Overall, C-L psychiatrists were less likely to prescribe citalopram/escitalopram following the Health Canada warning, which did not translate into safer dosing. Clinicians should not avoid prescribing citalopram/escitalopram appropriately in medically vulnerable inpatients when benefits outweigh disadvantages. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Estudo longitudinal do desenvolvimento da comunicação em diversas economias mundiais

OpenAIRE

Arruda Filho, Emílio José Montero

2012-01-01

O desenvolvimento do setor de comunicação de um país possui relações com o seu desenvolvimento econômico e é possível demonstrar essa conexão estatisticamente, como tem sido feito por pesquisadores de instituições como a ITU (International Telecommunications Union). Como esses dados estão apenas apresentados na forma simples e não levam em conta fatores de interconexão, é importante desenvolver pesquisas que avaliem a conexão entre variáveis relevantes no campo. Este trabalho visa analisar o...

Desenvolvimento do feijoeiro sob o uso de biofertilizante e adubação mineral.

OpenAIRE

Galbiatti, João A.; Silva, Flávia G. da; Franco, Claudenir F.; Caramelo, Anaira D.

2011-01-01

A produção intensiva de alimentos exige manejo adequado do solo para garantir a produtividade e a sustentabilidade ambiental. Uma das alternativas é a utilização de resíduos orgânicos no desenvolvimento das culturas, diminuindo a dependência de adubos minerais. Com o objetivo de avaliar o desenvolvimento da cultura de feijão (Phaseolus vulgaris L.), utilizando biofertilizante e adubação mineral, conduziu-se o experimento com seis tratamentos dispostos ao acaso, em esquema fatorial, em quatro ...

First Approximations of Prescribed Fire Risks Relative to Other Management Techniques Used on Private Lands.

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Dirac Twidwell

Full Text Available Fire is widely recognized as a critical ecological and evolutionary driver that needs to be at the forefront of land management actions if conservation targets are to be met. However, the prevailing view is that prescribed fire is riskier than other land management techniques. Perceived risks associated with the application of fire limits its use and reduces agency support for prescribed burning in the private sector. As a result, considerably less cost-share support is given for prescribed fire compared to mechanical techniques. This study tests the general perception that fire is a riskier technique relative to other land management options. Due to the lack of data available to directly test this notion, we use a combination of approaches including 1 a comparison of fatalities resulting from different occupations that are proxies for techniques employed in land management, 2 a comparison of fatalities resulting from wildland fire versus prescribed fire, and 3 an exploration of causal factors responsible for wildland fire-related fatalities. This approach establishes a first approximation of the relative risk of fatality to private citizens using prescribed fire compared to other management techniques that are readily used in ecosystem management. Our data do not support using risks of landowner fatalities as justification for the use of alternative land management techniques, such as mechanical (machine-related equipment, over prescribed fire. Vehicles and heavy machinery are consistently leading reasons for fatalities within occupations selected as proxies for management techniques employed by ranchers and agricultural producers, and also constitute a large proportion of fatalities among firefighters. Our study provides the foundation for agencies to establish data-driven decisions regarding the degree of support they provide for prescribed burning on private lands.

Desenvolvimento, complexo industrial da saúde e política industrial

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Gadelha Carlos Augusto Grabois

2006-01-01

Full Text Available O artigo situa a questão da saúde no contexto do desenvolvimento nacional e da política industrial. Tomou-se a idéia de corte estruturalista, marxista e schumpeteriano, onde a indústria e as inovações constituem os elementos determinantes do dinamismo das economias capitalistas e de sua posição relativa na economia mundial. Todos os países que se desenvolveram e passaram a competir em melhores condições com os países avançados associaram uma indústria forte com uma base endógena de conhecimento, de aprendizado e de inovação. Todavia, na área da saúde essa visão é problemática, uma vez que os interesses empresariais se movem pela lógica econômica do lucro e não para o atendimento das necessidades da saúde. A noção de complexo industrial da saúde constitui uma tentativa e fornecer um referencial teórico que permita articular duas lógicas distintas: a sanitária e a do desenvolvimento econômico. O trabalho procurou mostrar, com base em dados de comércio exterior, como a desconsideração da lógica do desenvolvimento nas políticas de saúde levou a uma situação de vulnerabilidade econômica do setor que pode limitar os objetivos de universalidade, eqüidade e integralidade. Nesse contexto, propõe-se uma ruptura cognitiva e política com as visões antagônicas que colocam, de um lado, as necessidades da saúde e, de outro, da indústria. Um país que pretende chegar a uma condição de desenvolvimento e de independência requer, ao mesmo tempo, indústrias fortes e inovadoras, e um sistema de saúde inclusivo e universal.

Desenvolvimento, complexo industrial da saúde e política industrial

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Carlos Augusto Grabois Gadelha

2006-08-01

Full Text Available O artigo situa a questão da saúde no contexto do desenvolvimento nacional e da política industrial. Tomou-se a idéia de corte estruturalista, marxista e schumpeteriano, onde a indústria e as inovações constituem os elementos determinantes do dinamismo das economias capitalistas e de sua posição relativa na economia mundial. Todos os países que se desenvolveram e passaram a competir em melhores condições com os países avançados associaram uma indústria forte com uma base endógena de conhecimento, de aprendizado e de inovação. Todavia, na área da saúde essa visão é problemática, uma vez que os interesses empresariais se movem pela lógica econômica do lucro e não para o atendimento das necessidades da saúde. A noção de complexo industrial da saúde constitui uma tentativa e fornecer um referencial teórico que permita articular duas lógicas distintas: a sanitária e a do desenvolvimento econômico. O trabalho procurou mostrar, com base em dados de comércio exterior, como a desconsideração da lógica do desenvolvimento nas políticas de saúde levou a uma situação de vulnerabilidade econômica do setor que pode limitar os objetivos de universalidade, eqüidade e integralidade. Nesse contexto, propõe-se uma ruptura cognitiva e política com as visões antagônicas que colocam, de um lado, as necessidades da saúde e, de outro, da indústria. Um país que pretende chegar a uma condição de desenvolvimento e de independência requer, ao mesmo tempo, indústrias fortes e inovadoras, e um sistema de saúde inclusivo e universal.

ESTRUTURA FUNDIÁRIA E DESENVOLVIMENTO HUMANO: UMA ANÁLISE PARA AS MICRORREGIÕES DO RIO GRANDE DO SUL

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Adilson Giovanini

2011-12-01

Full Text Available A partir da perspectiva do desenvolvimento como expansão das capacitações de Amartya Sen, o artigo testa a hipótese de que a concentração fundiária pode ser um fator prejudicial ao desenvolvimento humano nas microrregiões do Rio Grande do Sul. A pesquisa se caracteriza como histórico-empírica na medida em que busca na história a contextualização da atual estrutura fundiária e estatística e econométrica uma vez que estima a relação entre indicadores de desenvolvimento humano e de estrutura fundiária. Para tanto, calcula-se a correlação e ajustam-se regressões múltiplas entre indicadores de estrutura fundiária e de desenvolvimento humano. Um dos resultados encontrados é o de que as microrregiões com uma estrutura fundiária mais desigual possuem piores indicadores de expectativa de vida ao nascer.

CARTOGRAFIAS DO PIAUÍ: RELACIONANDO INFRAESTRUTURA E DESENVOLVIMENTO SOCIAL

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Paulo Antônio Barbosa Júnior

2016-08-01

Full Text Available Durante as décadas de 50 a 90, o Piauí foi o Estado mais pobre do Brasil. Recentemente, o Piauí tem apresentado acelerado crescimento econômico, devido em parte ao fortalecimento dos setores de comércio e construção, e a implantação da agricultura moderna na porção do Cerrado piauiense da região MAPITOBA. Apesar do recente incremento econômico, percebe-se que no Piauí, assim como em outros estados do Brasil, o desenvolvimento se dá de forma irregular com relação aos aspectos sociais e seus padrões de distribuição no território. Neste sentido, o presente trabalho busca mostrar que no Piauí a concentração de bens e pessoas está em parte condicionada a infraestrutura de transporte, com exceção da mesorregião Sudoeste Piauiense, onde o modelo de desenvolvimento adotado é essencialmente diferente do modelo das demais regiões. Desta forma, a baixa integração regional no Piauí tem contribuído para o surgimento de duas porções territoriais distintas e isoladas: uma ao norte, com características predominantemente urbanas e relativa concentração de bens e pessoas; e outra ao sul, onde se estabeleceu a última fronteira agrícola do país, com a implantação da agricultura moderna em áreas de vazios demográficos e baixos índices de desenvolvimento social. Assim, partindo-se da demanda por estudos que melhor descrevam as especificidades do território e que contribuam para a elaboração de políticas públicas adjetivadas ao local, o trabalho faz uso da Cartografia Temática e da Análise Espacial para descrever a situação atual do estado do Piauí com relação a Renda e Educação.

Disponibilidades e auto-implicação: desenvolvimento profissional e plurilinguismo

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Gonçalves, Maria de Lurdes

2007-01-01

Full Text Available A crescente importância e o relevo que o plurilinguismo vem adquirindo, alargou o âmbito do trabalho dos docentes de línguas. Assim, a educação plurilingue e intelectual constitui um importante desafio para o crescimento profissional de um educador em línguas, sendo os programas de formação, enquanto mecanismos de desenvolvimento profissional, uma condição necessária para responder a esse desafio. Este texto apresenta um programa de formação para o desenvolvimento do plurilinguismo e analisa as disponibilidades e auto-implicação que esta proposta de formação encontrou no seio do grupo de professores de línguas de uma escola secundária em Portugal

A CONTRIBUIÇÃO DO GERENCIAMENTO DE PROJETOS NO PROCESSO DE DESENVOLVIMENTO DE PRODUTOS

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Paulo Fernando Pinto Barcellos

2014-09-01

Full Text Available Em um ambiente complexo, caracterizado por uma demanda crescente de produtos customizados e personalizados, a diminuição do tempo de ciclo para o lançamento de novos produtos torna-se um ponto importante para obtenção de um maior retorno do investimento nos projetos de desenvolvimento. Assim, o objetivo proposto neste artigo foi investigar a contribuição das metodologias de gerenciamento de projetos para a diminuição do tempo de desenvolvimento de produtos. Para a realização deste estudo, e tendo em vista o objetivo proposto, foi utilizada metodologia qualitativa bibliográfica. As análises, realizadas no sentido de entender qual o tipo de processo de gerenciamento de projetos pode melhor contribuir para o desenvolvimento de produtos, trouxeram resultados contraditórios no sentido da utilização de métodos prescritivos e adaptativos. Este fato levou a reflexão de que a contribuição apresentada pelas práticas de gerenciamento de projetos para o desenvolvimento de produtos se dá com a verificação do cenário e o grau de inovação do projeto de produto que está sendo desenvolvido e com a utilização de metodologias adaptativas para projetos inovadores em ambientes complexos e metodologias prescritivas para projetos de concepção de rotina em ambientes simples.

POLITIZAÇÃO, AMBIENTALIZAÇÃO E DESENVOLVIMENTO TERRITORIAL EM RESERVAS EXTRATIVISTAS

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Maria José da S. A. Teisserenc

Full Text Available Esse artigo, resultante de pesquisas no contexto de duas Resex marinhas do estado do Pará, Mãe Grande do Curuçá e São João da Ponta, trata de mudanças que vêm ocorrendo no poder local, relacionadas à criação de áreas protegidas na Amazônia brasileira. Observa-se, então, uma politização dos desafios locais, manifesta como resultado do trabalho realizado nos Conselhos Deliberativos, nos quais a mobilização das comunidades e o engajamento de seus representantes possibilitam debates que dizem respeito ao desenvolvimento de seu território conforme exigências ambientais. Trata-se de uma dinâmica significativa de um desenvolvimento territorial que se beneficia de uma ambientalização geral gerada com a criação das Reservas e do valor deliberativo dos compromissos de membros conselheiros como uma instância política. Essa situação constitui interessante oportunidade de análise das relações entre práticas de democracia local de tipo deliberativo e uma orientação de desenvolvimento que inspira o engajamento dos atores locais em instituições novas, como os Conselhos Deliberativos.

AGROECOLOGIA: UMA ALTERNATIVA DE DESENVOLVIMENTO RURAL SUSTENTÁVEL PARA OS ASSENTAMENTOS RURAIS

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Nivea Massaretto Verges

2013-03-01

Full Text Available Atualmente, observa-se o aumento das discussões, dentro das dimensões acadêmica, econômica, política e social, em relação à agricultura do país e do mundo, dentre as discussões está a questão do desenvolvimento rural sustentável, que existe em documentos, porém está ausente na prática. Um exemplo da ausência do desenvolvimento rural sustentável pode ser encontrado nas famílias de produtores assentadas que, em meio a muitas pressões, acabam se rendendo ao capital, deixando de produzir e desenvolver em seus lotes. Diante disso, este trabalho buscou analisar as características dos assentamentos rurais do Pontal do Paranapanema, identificando seus potenciais e impasses a fim de apresentar as práticas agroecológicas como alternativa para o desenvolvimento rural sustentável dos assentamentos, destacando alguns esboços para um projeto a fim de proporcionar embasamento para que o processo de integração econômica e social dos assentados seja efetivado de forma autônoma pelos mesmos. Para a realização desse trabalho foi utilizado levantamentos bibliográficos e dados obtidos junto ao IBGE e DATALUTA.

Desdobramento da qualidade no desenvolvimento de filmes flexíveis para embalagens

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Miguel Paulo A. Cauchick

2003-01-01

Full Text Available Um dos métodos atuais importantes para o desenvolvimento de produtos é o QFD (Quality Function Deployment ou Desdobramento da Função Qualidade. O QFD consiste em um processo sistemático para traduzir a opinião do cliente em requisitos técnicos e operacionais, mostrando e documentando as informações na forma de matrizes. O método objetiva enfocar os itens mais importantes, proporcionando um mecanismo para alcançar vantagens competitivas no processo de desenvolvimento. Este trabalho destaca o conceito do QFD, citando uma aplicação em uma empresa que produz filmes flexíveis de polipropileno (BOPP. O trabalho apresenta alguns aspectos da introdução do método na empresa, apontando as dificuldades encontradas, resultados e benefícios decorrentes da implantação. Dentre os benefícios gerados, destacam-se a importância do papel do QFD como um método para sistematizar o processo de desenvolvimento, bem como outros benefícios para a equipe, tais como melhoria nas habilidades de planejamento, disseminação do conhecimento e melhoria de comunicação entre as áreas funcionais.

Resistindo ao desenvolvimento neocolonial: a luta do povo de Andalgalá contra projetos megamineiros

OpenAIRE

Misoczky,Maria Ceci; Böhm,Steffen

2013-01-01

A América Latina vem experimentando uma nova era de declarada fé dos governos no mito do desenvolvimento, em articulação com a expansão de políticas extrativistas exportadoras em um contexto de renovada dependência. A face mais dramática do extrativismo na região tem sido a crescente presença de corporações mineiras transnacionais apoiadas por governos nacionais e regionais e por instituições internacionais financeiras e de apoio ao desenvolvimento, e intensamente resistidas por movimentos so...

What drives the prescribing of growth hormone preparations in England? Prices versus patient preferences.

Science.gov (United States)

Chapman, Stephen R; Fitzpatrick, Raymond W; Aladul, Mohammed I

2017-04-11

The patent expiry of a number of biological medicines and the advent of biosimilars raised the expectations of healthcare commissioners that biosimilars would reduce the high cost of these medicines and produce potential savings to the NHS. We aimed to examine the prescribing pattern of different growth hormone preparations (ready to use and reconstitution requiring) in primary and secondary care in England to determine relative rates of decrease or increase and identify the possible factors influencing prescribing following the introduction of biosimilar growth hormone in 2008. Longitudinal observational study. Primary care prescribing cost and volume data was derived from the NHS business services authority website, and for secondary care from the DEFINE database, between April 2011 and December 2015. Quarterly prescribing analysis to examine trends and measure the relationship between usage and price. Expenditure and usage of growth hormone in primary care decreased by 17.91% and 7.29%, respectively, whereas expenditure and usage in secondary care increased by 68.41% and 100%, respectively, between April 2011 and December 2015. The usage of reconstitution requiring products significantly declined in primary care (R²=0.9292) and slightly increased in use in secondary care (R²=0.139). In contrast, the usage of ready-to-use products significantly increased in use in primary (R²=0.7526) and secondary care (R²=0.9633), respectively. Weak or no correlation existed between the usage and price of growth hormone preparations in primary and secondary care. The price of growth hormone products was not the key factor influencing the prescribing of the biological medicines. The main driver for specific product selection was the ease of use and the number of steps in dose preparation. Prescribers appear to be taking into account patient preferences rather than cost in their prescribing decisions. Published by the BMJ Publishing Group Limited. For permission to use (where

Avaliação do desenvolvimento cognitivo e afetivo-social de crianças com perda auditiva

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Maria de Lourdes M. Tabaquim

2013-12-01

Full Text Available OBEJTIVO: avaliar o nível de desenvolvimento cognitivo e afetivo-social de crianças com diagnóstico de deficiência auditiva. MÉTODO: participaram do estudo 50 crianças com diagnóstico de deficiência auditiva, com idade média de 16,1 meses, de ambos os gêneros. Empregou-se a entrevista semi-estruturada com os pais para a obtenção da história de vida da criança, a Escala de Desenvolvimento Comportamental e a Escala de Avaliação da Reação de Retração do Bebê. RESULTADO: o estudo identificou 80% das crianças com perda auditiva profunda bilateral. O Quociente de Desenvolvimento na normalidade ocorreu em 76% da amostra, sendo as funções da linguagem e pessoal-social, as mais prejudicadas. Os níveis de ajustamento afetivo e interacional foram caracterizados pelas reações de alarme para problemas de interação pessoal-social. CONCLUSÃO: as competências defasadas de habilidades verbais e não-verbais mostraram implicações no desenvolvimento cognitivo, sugestivas da condição da criança com perda auditiva e dos fatores de risco associados, com limitação circunstancial a trocas comunicativas que promovem o desenvolvimento de competências adaptativas e o fortalecimento da auto-estima para as relações.

Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior.

Science.gov (United States)

Tang, Yan; Chang, Chung-Chou H; Lave, Judith R; Gellad, Walid F; Huskamp, Haiden A; Donohue, Julie M

2016-03-01

Physicians face the choice of multiple ingredients when prescribing drugs in many therapeutic categories. For conditions with considerable patient heterogeneity in treatment response, customizing treatment to individual patient needs and preferences may improve outcomes. To assess variation in the diversity of antipsychotic prescribing for mental health conditions, a necessary although not sufficient condition for personalizing treatment. To identify patient caseload, physician, and organizational factors associated with the diversity of antipsychotic prescribing. Using 2011 data from Pennsylvania's Medicaid program, IMS Health's HCOSTM database, and the AMA Masterfile, we identified 764 psychiatrists who prescribed antipsychotics to 10 patients. We constructed three physician-level measures of diversity/concentration of antipsychotic prescribing: number of ingredients prescribed, share of prescriptions for most preferred ingredient, and Herfindahl-Hirschman index (HHI). We used multiple membership linear mixed models to examine patient caseload, physician, and healthcare organizational predictors of physician concentration of antipsychotic prescribing. There was substantial variability in antipsychotic prescribing concentration among psychiatrists, with number of ingredients ranging from 2-17, share for most preferred ingredient from 16%-85%, and HHI from 1,088-7,270. On average, psychiatrist prescribing behavior was relatively diversified; however, 11% of psychiatrists wrote an average of 55% of their prescriptions for their most preferred ingredient. Female prescribers and those with smaller shares of disabled or serious mental illness patients had more concentrated prescribing behavior on average. Antipsychotic prescribing by individual psychiatrists in a large state Medicaid program varied substantially across psychiatrists. Our findings illustrate the importance of understanding physicians' prescribing behavior and indicate that even among specialties

Asthma medication prescribing before, during and after pregnancy: a study in seven European regions.

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Charlton, Rachel A; Pierini, Anna; Klungsøyr, Kari; Neville, Amanda J; Jordan, Susan; de Jong-van den Berg, Lolkje T W; Thayer, Daniel; Bos, H Jens; Puccini, Aurora; Hansen, Anne V; Gini, Rosa; Engeland, Anders; Nybo Andersen, Anne-Marie; Dolk, Helen; Garne, Ester

2016-01-19

To explore utilisation patterns of asthma medication before, during and after pregnancy as recorded in seven European population-based databases. A descriptive drug utilisation study. 7 electronic healthcare databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna and Tuscany), Wales, and the Clinical Practice Research Datalink representing the rest of the UK. All women with a pregnancy ending in a delivery that started and ended between 2004 and 2010, who had been present in the database for the year before, throughout and the year following pregnancy. The percentage of deliveries where the woman received an asthma medicine prescription, based on prescriptions issued (UK) or dispensed (non-UK), during the year before, throughout or during the year following pregnancy. Asthma medicine prescribing patterns were described for 3-month time periods and the choice of asthma medicine and changes in prescribing over the study period were evaluated in each database. In total, 1,165,435 deliveries were identified. The prevalence of asthma medication prescribing during pregnancy was highest in the UK and Wales databases (9.4% (CI95 9.3% to 9.6%) and 9.4% (CI95 9.1% to 9.6%), respectively) and lowest in the Norwegian database (3.7% (CI95 3.7% to 3.8%)). In the year before pregnancy, the prevalence of asthma medication prescribing remained constant in all regions. Prescribing levels peaked during the second trimester of pregnancy and were at their lowest during the 3-month period following delivery. A decline was observed, in all regions except the UK, in the prescribing of long-acting β-2-agonists during pregnancy. During the 7-year study period, there were only small changes in prescribing patterns. Differences were found in the prevalence of prescribing of asthma medications during and surrounding pregnancy in Europe. Inhaled β-2 agonists and inhaled corticosteroids were, however, the most popular therapeutic regimens in all databases. Published by the BMJ

Contraceptive Provision to Adolescent Females Prescribed Teratogenic Medications.

Science.gov (United States)

Stancil, Stephani L; Miller, Melissa; Briggs, Holley; Lynch, Daryl; Goggin, Kathy; Kearns, Gregory

2016-01-01

Rates of adult women receiving contraceptive provision when simultaneously prescribed a known teratogen are alarmingly low. The prevalence of this behavior among pediatric providers and their adolescent patients is unknown. The objective of this study was to describe pediatric provider behaviors for prescribing teratogens concurrently with counseling, referral, and/or prescribing of contraception (collectively called contraceptive provision) in the adolescent population. A retrospective review was conducted examining visits in 2008-2012 by adolescents aged 14 to 25 years in which a known teratogen (US Food and Drug Administration pregnancy risk category D or X) was prescribed. The electronic medical records were queried for demographic information, evidence of contraceptive provision, and menstrual and sexual histories. The data were analyzed using standard statistical methods. Within 4172 clinic visits, 1694 females received 4506 prescriptions for teratogenic medications. The most commonly prescribed teratogens were topiramate, methotrexate, diazepam, isotretinoin, and enalapril. The subspecialties prescribing teratogens most frequently were neurology, hematology-oncology, and dermatology. Overall, contraceptive provision was documented in 28.6% of the visits. Whites versus nonwhites and older versus younger girls were more likely to receive contraceptive provision. The presence of a federal risk mitigation system for the teratogen also increased the likelihood of contraceptive provision. Our data demonstrate female adolescents prescribed teratogens receive inadequate contraception provision, which could increase their risk for negative pregnancy outcomes. Although the presence of a federal risk mitigation system appears to improve contraceptive provision, these systems are costly and, in some instances, difficult to implement. Efforts to improve provider practices are needed. Copyright © 2016 by the American Academy of Pediatrics.

Validity of the Prescriber Information in the Danish National Prescription Registry

DEFF Research Database (Denmark)

Rasmussen, Lotte; Valentin, Julie; Gesser, Katarina Margareta

2016-01-01

The aim of this study was to measure the validity of the prescriber information recorded in the Danish National Prescription Registry (DNPR). The prescriber information recorded in the pharmacies' electronic dispensing system was considered to represent the prescriber information recorded...... in the DNPR. Further, the problem of validity of the prescriber information pertains only to non-electronic prescriptions, as these are manually entered into the dispensing system. The recorded prescriber information was thus validated against information from a total of 2,000 non-electronic prescriptions...... at five Danish community pharmacies. The validity of the recorded prescriber information was measured at the level of the individual prescriber and the prescriber type, respectively. The proportion of non-electronic prescriptions with incorrect registrations was 22.4% (95% Confidence Interval (CI): 20...

Fatores prognósticos para o desenvolvimento cognitivo de prematuros de muito baixo peso

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Maria Dalva Barbosa Baker Méio

2003-06-01

Full Text Available OBJETIVO: Crianças prematuras, de muito baixo peso, podem apresentar alterações em seu desenvolvimento cognitivo. No Brasil, pouco se conhece sobre a evolução dessas crianças na idade pré-escolar. O objetivo do estudo foi descrever o desenvolvimento cognitivo de uma população de recém-nascidos prematuros de muito baixo peso e verificar possíveis fatores prognósticos para desenvolvimento cognitivo anormal. MÉTODOS: Um estudo de coorte foi realizado com uma população de crianças pré-escolares, nascidas prematuras, de muito baixo peso, entre janeiro de 1991 e setembro de 1993. O desenvolvimento cognitivo foi avaliado por meio do teste WPPSI-R (Wechsler Preschool and Primary Intelligence Scales aplicado por psicólogas, utilizando dois pontos de corte para definição de anormalidade: escores abaixo de 1 e 2, desvios padrões da média (DP. RESULTADOS: Foram avaliadas 79 crianças de quatro a cinco anos de idade. A média do escore total do teste WIPPSI-R foi de 75,6 (±11,9. A incidência de escore total anormal foi de 77,2% e de 32,9% (1DP e 2 DP, respectivamente. Após o ajuste por "tipo de parto", ser pequeno para a idade gestacional (OR=6,19; IC95% 1,60-23,86, ultra-som transfontanela anormal (OR=5,90; IC95% 1,04-9,83 e ser do sexo masculino (OR=3,20; IC 95% 1,32-26,35 foram os fatores que predisseram escore total <70 (2 DP. CONCLUSÃO: Houve maior comprometimento do desenvolvimento cognitivo nas crianças estudadas do que o descrito na literatura. Ser pequeno para idade gestacional, ultra-som transfontanela anormal e sexo masculino foram fatores prognósticos de pior evolução.

DESENVOLVIMENTO LOCAL E MANEJO DA CAATINGA NO ASSENTAMENTO HIPÓLITO, EM MOSSORÓ/RN

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E. D. G. Pereira

2007-12-01

Full Text Available Nas últimas décadas tem havido uma preocupação muito grande com o tipo de desenvolvimento que vem sendo implementado pelos governos. A partir daí, criou-se a noção de desenvolvimento sustentável, o qual se baseia em um crescimento econômico que seja acompanhado por eqüidade social e prudência ecológica. Em muitos projetos de assentamentos têm sido desenvolvidos pesquisas com o objetivo de analisar como vem se processando tais experiências. Nossa investigação teve como meta verificar os impactos sócio-ambientais trazidos a partir do uso da caatinga no assentamento Hipólito, no município de Mossoró, no Oeste do RN. Preocupou-nos saber se naquele projeto de assentamento tem ocorrido um desenvolvimento local, baseado em critérios de sustentabilidade. A metodologia empregada foi a realização de entrevistas com 29 assentados, o que corresponde a 20% da população total do assentamento, além de leituras de outros trabalhos e artigos de jornais. O trabalho está em fase de conclusão, porém a partir de estudos de campo, realizados no mês de agosto de 2004, podemos apresentar os seguintes resultados: quanto ao aspecto sócio-econômico, os assentados têm na agricultura de sequeiro a atividade econômica principal; a produtividade é baixa e a renda é complementada com “bicos”, aposentadorias e/ou com o dinheiro advindo dos planos de assistência social do Governo Federal; a agricultura é realizada sem os devidos cuidados com o meio ambiente, e o desmatamento desordenado tem agravado ainda mais os problemas presentes no bioma caatinga, tais como salinização, a desertificação e o desaparecimento de espécies da fauna e da flora. Face ao exposto, podemos concluir que a realidade observada no assentamento aponta para a insustentabilidade sócio-econômica e ambiental naquela área. Palavras-chave: sustentabilidade; caatinga; assentamento; desenvolvimento rural; desenvolvimento local.

Stakeholder views on the impact of nurse prescribing on dermatology services.

Science.gov (United States)

Carey, Nicola; Stenner, Karen; Courtenay, Molly

2010-02-01

To explore stakeholder views on the impact of nurse prescribing on dermatology services. Nurse led care enhances the services that dermatology patients receive. Research indicates that care delivered by nurse prescribers can improve efficiency and access to medicines. There is no evidence exploring the impact of nurse prescribing on the configuration of dermatology services. Case study. A collective case study of 10 practice settings across England where nurses prescribed medicines for dermatology patients. A thematic analysis of semi-structured interview data collected during 2006 and 2007. Participants were qualified nurse prescribers, administrative staff, doctors and non-nurse prescribers. Nurse prescribing was reported to support and facilitate the modernisation of dermatology services. It enabled nurses to make effective use of their knowledge and skills, overcome delays in treatment and provide faster access to medicines. However several organisational issues restricted the success of the initiative. Nurse prescribing is successfully being used to support and deliver a range of services to dermatology patients. Stakeholders reported that both patients and staff had benefited by the adoption of this role by nurses. However issues over support and access to CPD and capacity of the workforce were identified as potential barriers which could affect the contribution of nurse prescribing to dermatology patients. Nurse prescribing contributes to the services provided to dermatology patients; Nurse supplementary prescribing contributes to the ability of dermatology nurse specialists to work in teams and prescribe complex medicines; Provision of adequate support and strategic planning are essential if the impact of nurse prescribing is to be fully realised.

The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study.

Science.gov (United States)

Franklin, Bryony Dean; O'Grady, Kara; Donyai, Parastou; Jacklin, Ann; Barber, Nick

2007-08-01

To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (pMedical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; chi(2) test). A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

Does non-medical prescribing make a difference to patients?

Science.gov (United States)

Carey, Nicola; Stenner, Karen

This article examines the literature on non-medical prescribing to establish its impact on UK healthcare. It discusses how better access to medication through non-medical prescribing can improve patient safety and patient-centred care, and how nurse prescribing can help ensure quality of care in the NHS during the current financial crisis.

Effect of season and interval of prescribed burn on ponderosa pine butterfly defoliation patterns

Science.gov (United States)

Becky K. Kerns; Douglas J. Westlind

2013-01-01

Current knowledge concerning the interactions between forest disturbances such as fire and insect defoliation is limited. Wildfires and prescribed burns may influence the intensity and severity of insect outbreaks by affecting the vigor of residual trees, altering aspects of stand structure and abundance of preferred hosts, and by changing the physical environment...

Relação entre saúde e saneamento na perspectiva do desenvolvimento

OpenAIRE

Heller,Léo

1998-01-01

Discute-se a relação entre saúde e saneamento, situando-a no contexto do processo de desenvolvimento social. É defendida inicialmente a inserção dessa relação no atual enfoque saúde e ambiente, reconhecendo que esta nova área não elimina a pertinência da abordagem saúde-saneamento, na verdade sua precursora. Apresenta-se a conceituação de saneamento e sua atual situação no país, além dos marcos conceituais da relação saúde-saneamento. Indicadores de desenvolvimento dos países, enfatizando os ...

Aprimorando a Gerência e o Desenvolvimento de Software com Metodologias Ágeis

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Mauricio Andreazza Sganderla

2016-07-01

Full Text Available Este artigo aborda a melhoria da gerência e construção de software utilizando as metodologias ágeis eXtreme Programming e Scrum. São aplicadas as melhores práticas de ambas as metodologias em uma equipe de desenvolvimento de software, em um ambiente em que não havia nenhum processo bem definido de desenvolvimento de software. A escolha pelo uso das metodologias ágeis foi definida, pois atende ao dinamismo do cenário atual, requisitos voláteis, ambiente mais colaborativo e menos burocrático, tendo como objetivo principal o software em funcionamento e que realmente traga retorno ao cliente.

Medication discussion between nurse prescribers and people with diabetes

DEFF Research Database (Denmark)

Sibley, Andrew; Latter, Sue; Richard, Claude

2011-01-01

Aim. This paper is a report of a study to identify the content of, and participation in, medicine discussion between nurse prescribers and people with diabetes in England. Background. Diabetes affects 246 million people worldwide and effective management of medicines is an essential component...... of successful disease control. There are now over 20,000 nurse independent prescribers in the UK, many of whom frequently prescribe for people with diabetes. With this responsibility comes a challenge to effectively communicate with patients about medicines. National guidelines on medicines communication have...... recently been issued, but the extent to which nurse prescribers are facilitating effective medicine-taking in diabetes remains unknown. Methods. A purposive sample of 20 nurse prescribers working with diabetes patients audio-recorded 59 of their routine consultations and a descriptive analysis...

Desenvolvimento de coleções: origem dos fundamentos contemporâneos

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Simone da Rocha Weitzel

Full Text Available O artigo apresenta o resultado de uma pesquisa cujo objetivo foi identificar as correspondências entre os fundamentos da área hoje denominada de desenvolvimento de coleções e aqueles estabelecidos no século XIX, a fim de reconstruir os principais conceitos, métodos e práticas da área. Propõe um estudo exploratório para viabilizar essa correspondência a partir de oito obras escolhidas de autores europeus do século XIX, a maioria bibliófilos reconhecidos, a saber: Peignot (1823, Namur (1834, Hesse (1841, Rouveyre (1878, Richard (1883, Gräsel (1893, Petzholdt (1894 e Maire (1896. Essas obras serão analisadas a partir de três categorias contemporâneas da área: desenvolvimento de coleções, seleção e aquisição, por meio do método de revisão de literatura. Conclui-se, por fim, que o fenômeno da explosão da informação afeta o processo de desenvolvimento de coleções como um todo desde o século XVIII. Os autores do século XIX selecionados para o estudo apresentaram várias soluções - as quais fortaleceram o que hoje é denominado de abordagem baseada no acesso à informação - para lidar com a complexidade gerada pelo fenômeno da explosão da informação.

Impact of generic substitution decision support on electronic prescribing behavior.

Science.gov (United States)

Stenner, Shane P; Chen, Qingxia; Johnson, Kevin B

2010-01-01

To evaluate the impact of generic substitution decision support on electronic (e-) prescribing of generic medications. The authors analyzed retrospective outpatient e-prescribing data from an academic medical center and affiliated network for July 1, 2005-September 30, 2008 using an interrupted time-series design to assess the rate of generic prescribing before and after implementing generic substitution decision support. To assess background secular trends, e-prescribing was compared with a concurrent random sample of hand-generated prescriptions. Proportion of generic medications prescribed before and after the intervention, evaluated over time, and compared with a sample of prescriptions generated without e-prescribing. The proportion of generic medication prescriptions increased from 32.1% to 54.2% after the intervention (22.1% increase, 95% CI 21.9% to 22.3%), with no diminution in magnitude of improvement post-intervention. In the concurrent control group, increases in proportion of generic prescriptions (29.3% to 31.4% to 37.4% in the pre-intervention, post-intervention, and end-of-study periods, respectively) were not commensurate with the intervention. There was a larger change in generic prescribing rates among authorized prescribers (24.6%) than nurses (18.5%; adjusted OR 1.38, 95% CI 1.17 to 1.63). Two years after the intervention, the proportion of generic prescribing remained significantly higher for e-prescriptions (58.1%; 95% CI 57.5% to 58.7%) than for hand-generated prescriptions ordered at the same time (37.4%; 95% CI 34.9% to 39.9%) (p<0.0001). Generic prescribing increased significantly in every specialty. Implementation of generic substitution decision support was associated with dramatic and sustained improvements in the rate of outpatient generic e-prescribing across all specialties.

Nurse prescribing ethics and medical marketing.

Science.gov (United States)

Adams, J

This article suggests that nurse prescribers require an awareness of key concepts in ethics, such as deontology and utilitarianism to reflect on current debates and contribute to them. The principles of biomedical ethics have also been influential in the development of professional codes of conduct. Attention is drawn to the importance of the Association of the British Pharmaceutical Industry's code of practice for the pharmaceutical industry in regulating marketing aimed at prescribers.

Desenvolvimento floral de Sinningia leucotricha (Hohne Moore, Gesneriaceae (rainha-do-abismo.

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Lúcia Iuchi

1997-05-01

Full Text Available Flores de rainha-do-abismo, Sinni'ngi'a leucotricha (Hoehne Moore, em vários estádios de desenvolvimento, foram utilizadas para medição, descrição e documentação fotográfica, com o objetivo de estudar o desenvolvimento floral e verificar como ocorre naturalmente a polinização dessa espécie. Em trabalhos de cruzamentos, as flores de Rainha-do-abismo devem ser emasculadas com 3 cm de comprimento (estádio 3, quando as anteras ainda se encontram fechadas, para não correr o risco de uma autofecundação. As flores dessa espécie apresentaram uma dicogamia protândrica numa extensão tal que dificultou a autofecundação, mas não a impediu totalmente.

Predicted effects of prescribed burning and harvesting on forest recovery and sustainability in southwest Georgia, USA.

Science.gov (United States)

Garten, Charles T

2006-12-01

A model-based analysis of the effect of prescribed burning and forest thinning or clear-cutting on stand recovery and sustainability was conducted at Fort Benning, GA, in the southeastern USA. Two experiments were performed with the model. In the first experiment, forest recovery from degraded soils was predicted for 100 years with or without prescribed burning. In the second experiment simulations began with 100 years of predicted stand growth, then forest sustainability was predicted for an additional 100 years under different combinations of prescribed burning and forest harvesting. Three levels of fire intensity (low, medium, and high), that corresponded to 17%, 33%, and 50% consumption of the forest floor C stock by fire, were evaluated at 1-, 2-, and 3-year fire return intervals. Relative to the control (no fire), prescribed burning with a 2- or 3-year return interval caused only a small reduction in predicted steady state soil C stocks (burns did adversely impact forest recovery and sustainability (after harvesting) on less sandy soils, but not on more sandy soils that had greater N availability. Higher intensity and frequency of ground fires increased the chance that tree biomass would not return to pre-harvest levels. Soil N limitation was indicated as the cause of unsustainable forests when prescribed burns were too frequent or too intense to permit stand recovery.

Aspectos biométricos do desenvolvimento testicular e corporal em cutias (Dasyprocta aguti criadas em cativeiros

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Antônio Chaves de Assis-Neto

2003-01-01

Full Text Available Analisou-se os dados biométricos do desenvolvimento testicular e peso corporal de 31 cutias (Dasyprocta aguti desde o nascimento até os 14 meses de idade. As correlações entre o peso corporal, idade e parâmetros testiculares apresentaram-se altamente significativas. O peso testicular, o volume testicular, assim como os demais parâmetros biométricos testiculares (comprimento, diâmetro e perímetro, evoluíram lenta e gradualmente até os 8 meses de idade. A partir dos 9 meses, o crescimento foi mais rápido. O desenvolvimento biométrico do testículo pode ser dividido em duas fases, de 0 - 8 meses e de 9 - 14 meses de idade, sendo 9 meses considerado ponto de corte em se tratando de desenvolvimento testicular de cutias criadas em cativeiro.

IMPLICAÇÕES DAS CONCEPÇÕES DE EMPREENDER PARA O DESENVOLVIMENTO DA COMPETÊNCIA EMPREENDEDORA

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Rubens de Araujo Amaro

2013-12-01

Full Text Available Esse artigo analisa como as diferentes concepções de empreender influenciam o desenvolvimento da competência empreendedora, tomando como referência o pressuposto fenomenográfico de que um mesmo fenômeno é experienciado de diferentes maneiras pelos indivíduos. Fundamentada em uma ontologia relacional, pouco presente em estudos da competência, essa pesquisa fenomenográfica foi realizada com um grupo de participantes de um programa de pré-incubação de uma universidade paulista. Os resultados apontam para a existência de três diferentes maneiras de experienciar o empreender, que resultam em formas distintas de desenvolvimento da competência empreendedora. Com base nessas evidências, apresenta-se um conjunto de reflexões sobre o que é a competência profissional e algumas implicações para o seu desenvolvimento.

Desenvolvimento sustentável e a sociedade da informação: uma parceria natural?

Directory of Open Access Journals (Sweden)

Ariadne C. Furnival

Full Text Available Nci forma de uma revisão da literatura, é examinada a hipótese de que o advento da cliamada "sociedade pós industrial" ou "sociedade da informação" tem dado lugar a um período de atividade socio-econômico que representa uma mudança radical do modo anterior de desenvolvimento. E discutido o consenso de que a dinâmica desta nova forma de sociedade favorece um tipo de desenvolvimento econômico e social ecologicamente mais sustentável, principalmente porque o novo paradigma tem como seu eixo a informação e atividades relacionadas a ela, o que promoveria uma suposta "desmaterialização" da sociedade. A questão das formas com as quais este novo paradigma de desenvolvimento pode, ou não, afetar os chamados "países recém desenvolvidos" é também discutida.

Relação entre tamanho e desenvolvimento de competências organizacionais em multinacionais brasileiras

Directory of Open Access Journals (Sweden)

Felipe Mendes Borini

2012-12-01

Full Text Available O objetivo neste artigo é verificar a importância do tamanho da empresa no desenvolvimento de competências. O pressuposto central é que multinacionais brasileiras de pequeno porte precisam desenvolver mais competências organizacionais quando comparadas com multinacionais de grande porte. Os dados decorrem de um survey que obteve a resposta de 92 empresas brasileiras, a saber: 48 multinacionais de grande porte e 44 multinacionais de pequeno porte. Técnicas estatísticas de análise fatorial e modelagem linear generalizada são usadas para verificar a influência do tamanho da multinacional no desenvolvimento de competências. O resultado mostra que multinacionais brasileiras de pequeno porte desenvolvem mais competências no exterior quando comparadas com as grandes empresas. Portanto, ao menos para as multinacionais brasileiras, como representantes das empresas de países emergentes, o tamanho é um aspecto central para explicar as estratégias de desenvolvimento de competências no exterior.

Effects of MHRA drug safety advice on time trends in prescribing volume and indices of clinical toxicity for quinine

Science.gov (United States)

Acheampong, Paul; Cooper, Gill; Khazaeli, Behshad; Lupton, David J; White, Sue; May, Margaret T; Thomas, Simon H L

2013-01-01

Aims To ascertain the effects of the Medicines and Healthcare products Regulatory Agency's (MHRA) safety update in June 2010 on the volume of prescribing of quinine and on indices of quinine toxicity. Methods We analysed quarterly primary care total and quinine prescribing data for England and quinine prescribing volume for individual Primary Care Trusts in the North East of England from 2007/8 to 2011/12 obtained from the ePACT.net database. We also analysed quinine toxicity enquiries to the National Poisons Information Service (NPIS) via Toxbase® and by telephone between 2004/5 and 2011/12. Joinpoint regression and Pearson's correlation tests were used to ascertain changes in trends in prescribing and indices of toxicity and associations between prescribing and indices of toxicity, respectively. Results Total prescribing continued to increase, but annual growth in quinine prescribing in England declined from 6.0 to −0.6% following the MHRA update [difference −0.04 (95% confidence interval −0.07 to −0.01) quinine prescriptions per 100 patients per quarter, P = 0.0111]. Much larger reductions were observed in Primary Care Trusts that introduced comprehensive prescribing reviews. The previously increasing trend in Toxbase® quinine searches was reversed [difference −19.76 (95% confidence interval −39.28 to −9.20) user sessions per quarter, P = 0.0575]. Telephone enquiries to NPIS for quinine have declined, with stabilization of the proportion of moderate to severe cases of quinine poisoning since the update. Conclusions The MHRA advice was followed by limited reductions in the growth in quinine prescribing and in indicators of quinine overdose and toxicity. Quinine prescribing, however, remains common, and further efforts are needed to reduce availability and use. PMID:23594200

Nurse prescriber-patient consultations: a case study in dermatology.

Science.gov (United States)

Courtenay, Molly; Carey, Nicola; Stenner, Karen

2009-06-01

This paper is a report of a study exploring the content and processes in consultations between nurse prescribers and patients with dermatological conditions. Communication skills, consultation time, information and follow-up are central to the treatment and management of patients with dermatological conditions. The contribution nurses make to the care of these patients has great potential. A multiple case study was conducted with 10 practice settings across England in which nurses prescribed medicines for patients with dermatological conditions. Data were collected between June 2006 and September 2007 using semi-structured interviews (n = 40), patient questionnaires (n = 165/200) and videotaped observations of nurse consultations (n = 40). Data analysis included thematic analysis, descriptive statistics, chi-square and non-parametric tests. Nurses believed that their holistic approach to assessment, combined with their prescribing knowledge, improved prescribing decisions. Listening and explanation of treatments were aspects of nurse communication that were rated highly by patients. Listening and dealing sensitively with emotions were also aspects of the videotaped consultations that were rated highly by assessors. Nurses were less consistent in providing information about medicines. Triangulated data from this study suggest that nurse prescribing enhances the care of patients with dermatological conditions through improved prescribing decisions. If patients are to be more involved in this decision-making, nurses must give them more information about their medicines. The benefits of prescribing were most evident in the practices of dermatology specialist nurses. Further evidence is required to identify whether prescribing by specialist nurses offers similar benefits in other therapeutic areas.

Impacts of prescribed burning on soil greenhouse gas fluxes in a suburban native forest of south-eastern Queensland, Australia

Science.gov (United States)

Zhao, Y.; Wang, Y. Z.; Xu, Z. H.; Fu, L.

2015-11-01

Prescribed burning is a forest management practice that is widely used in Australia to reduce the risk of damaging wildfires. Prescribed burning can affect both carbon (C) and nitrogen (N) cycling in the forest and thereby influence the soil-atmosphere exchange of major greenhouse gases, i.e. carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O). To quantify the impact of a prescribed burning (conducted on 27 May 2014) on greenhouse gas exchange and the potential controlling mechanisms, we carried out a series of field measurements before (August 2013) and after (August 2014 and November 2014) the fire. Gas exchange rates were determined in four replicate plots which were burned during the combustion and in another four adjacent unburned plots located in green islands, using a set of static chambers. Surface soil properties including temperature, pH, moisture, soil C and N pools were also determined either by in situ measurement or by analysing surface 10 cm soil samples. All of the chamber measurements indicated a net sink of atmospheric CH4, with mean CH4 uptake ranging from 1.15 to 1.99 mg m-2 d-1. Prescribed burning significantly enhanced CH4 uptake as indicated by the significant higher CH4 uptake rates in the burned plots measured in August 2014. In the following 3 months, the CH4 uptake rate was recovered to the pre-burning level. Mean CO2 emission from the forest soils ranged from 2721.76 to 7113.49 mg m-2 d-1. The effect of prescribed burning on CO2 emission was limited within the first 3 months, as no significant difference was observed between the burned and the adjacent unburned plots in both August and November 2014. The CO2 emissions showed more seasonal variations, rather than the effects of prescribed burning. The N2O emission in the plots was quite low, and no significant impact of prescribed burning was observed. The changes in understory plants and litter layers, surface soil temperature, C and N substrate availability and microbial

Factor analysis improves the selection of prescribing indicators

DEFF Research Database (Denmark)

Rasmussen, Hanne Marie Skyggedal; Søndergaard, Jens; Sokolowski, Ineta

2006-01-01

OBJECTIVE: To test a method for improving the selection of indicators of general practitioners' prescribing. METHODS: We conducted a prescription database study including all 180 general practices in the County of Funen, Denmark, approximately 472,000 inhabitants. Principal factor analysis was us...... appropriate and inappropriate prescribing, as revealed by the correlation of the indicators in the first factor. CONCLUSION: Correlation and factor analysis is a feasible method that assists the selection of indicators and gives better insight into prescribing patterns....

Changing doctor prescribing behaviour

DEFF Research Database (Denmark)

Gill, P.S.; Mäkelä, M.; Vermeulen, K.M.

1999-01-01

Collaboration on Effective Professional Practice. This register is kept up to date by searching the following databases for reports of relevant research: DHSS-DATA; EMBASE; MEDLINE; SIGLE; Resource Database in Continuing Medical Education (1975-1994), along with bibliographies of related topics, hand searching......The aim of this overview was to identify interventions that change doctor prescribing behaviour and to derive conclusions for practice and further research. Relevant studies (indicating prescribing as a behaviour change) were located from a database of studies maintained by the Cochrane...... of key journals and personal contact with content area experts. Randomised controlled trials and non-equivalent group designs with pre- and post-intervention measures were included. Outcome measures were those used by the study authors. For each study we determined whether these were positive, negative...

A Novel Design for Drug-Drug Interaction Alerts Improves Prescribing Efficiency.

Science.gov (United States)

Russ, Alissa L; Chen, Siying; Melton, Brittany L; Johnson, Elizabette G; Spina, Jeffrey R; Weiner, Michael; Zillich, Alan J

2015-09-01

Drug-drug interactions (DDIs) are common in clinical care and pose serious risks for patients. Electronic health records display DDI alerts that can influence prescribers, but the interface design of DDI alerts has largely been unstudied. In this study, the objective was to apply human factors engineering principles to alert design. It was hypothesized that redesigned DDI alerts would significantly improve prescribers' efficiency and reduce prescribing errors. In a counterbalanced, crossover study with prescribers, two DDI alert designs were evaluated. Department of Veterans Affairs (VA) prescribers were video recorded as they completed fictitious patient scenarios, which included DDI alerts of varying severity. Efficiency was measured from time-stamped recordings. Prescribing errors were evaluated against predefined criteria. Efficiency and prescribing errors were analyzed with the Wilcoxon signed-rank test. Other usability data were collected on the adequacy of alert content, prescribers' use of the DDI monograph, and alert navigation. Twenty prescribers completed patient scenarios for both designs. Prescribers resolved redesigned alerts in about half the time (redesign: 52 seconds versus original design: 97 seconds; p<.001). Prescribing errors were not significantly different between the two designs. Usability results indicate that DDI alerts might be enhanced by facilitating easier access to laboratory data and dosing information and by allowing prescribers to cancel either interacting medication directly from the alert. Results also suggest that neither design provided adequate information for decision making via the primary interface. Applying human factors principles to DDI alerts improved overall efficiency. Aspects of DDI alert design that could be further enhanced prior to implementation were also identified.

Resistindo ao desenvolvimento neocolonial: a luta do povo de Andalgalá contra projetos megamineiros

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Maria Ceci Misoczky

Full Text Available A América Latina vem experimentando uma nova era de declarada fé dos governos no mito do desenvolvimento, em articulação com a expansão de políticas extrativistas exportadoras em um contexto de renovada dependência. A face mais dramática do extrativismo na região tem sido a crescente presença de corporações mineiras transnacionais apoiadas por governos nacionais e regionais e por instituições internacionais financeiras e de apoio ao desenvolvimento, e intensamente resistidas por movimentos sociais populares. Neste artigo apresentamos o caso de Andalgalá (uma pequena cidade na Província de Catamarca, na Argentina e as lutas do povo contra corporações mineiras transnacionais e seus aliados. Na tradição da Filosofia da Libertação e do método ana-dialético de Dussel, nos engajamos com o que tem sido denominado "comunidades argentinas do NÃO", expressando sua oposição a formas neocoloniais de desenvolvimento e gestão. Neste artigo estamos especificamente interessados em compreender como dois dispositivos gerencialistas usados pelas corporações mineiras, responsabilidade social corporativa (RSC e pactos de governança, impactam a luta do povo. Acima de tudo, este artigo oferece instantâneos de batalhas na linha de frente do extrativismo. Esperamos ter dado voz àquelas pessoas que normalmente não são ouvidas, criando um espaço para suas visões sobre um tipo diferente de desenvolvimento.

Biblioteca Digital do Supremo Tribunal Federal: uma proposta em desenvolvimento

Directory of Open Access Journals (Sweden)

Maria Tereza Machado Teles Walter

2017-12-01

Full Text Available As t e c n o l o g i as d e i nf o rm a ç ã o e d e c om u n i c a ç ã o revolucionaram as formas de organização e de mediação de informação em todas as instituições prestadoras de serviço, sejam elas bibliotecas ou centros de documentação. Seu desenvolvimento passou a ser uma questão estratégica de planejamento para as instituições que desejem manter-se em consonância com demandas cada vez mais especializadas e atender usuários que têm modelos mentais e conhecimentos de uso de informação em ambientes digitais. Reconhecendo esse cenário, foi elaborado, pela Coordenadoria de Biblioteca do Supremo Tribunal Federal, o projeto de desenvolvimento de sua Biblioteca Digital, cuja definição foi a de se tratava de um ambiente em meio eletrônico, para prestação de serviços e oferta de produtos, que incluem textos integrais e que independem da presença física dos usuários. O histórico desse projeto é apresentado incluindo as etapas e os perfis profissionais que atuaram no desenvolvimento do trabalho. Em função das características das propostas, todo o projeto foi modularizado visando facilitar sua implantação, de forma que independesse de mudanças na alta gestão do órgão. Alguns resultados dessa proposição são relacionados ao final.

O desenvolvimento da Competência Informacional nas crianças a partir da literatura infantil

OpenAIRE

Djuli Machado De Lucca; Clarice Fortkamp Caldin; João Primo Ramirez Righi

2015-01-01

Objetiva realizar uma reflexão acerca da prática de leitura de literatura infantil para o desenvolvimento da Competência Informacional nas crianças. A Competência Informacional é caracterizada por um movimento que estimula o uso crítico e reflexivo da informação. Trata da primeira fase de desenvolvimento da Competência Informacional, entendida, nesse artigo, como letramento informacional, que se constitui em um processo. É nessa fase que o indivíduo desenvolve habilidades básicas relacionadas...

A organização confessional e o desenvolvimento humano frente à pedagogia Montessori

OpenAIRE

Guilhon, Edite Maria Barbosa

2002-01-01

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Engenharia de Produção. Os fenômenos associados ao contexto das organizações e sua relação com o desenvolvimento humano dos profissionais nela envolvidos têm sido alvo de várias pesquisas e reflexões. Embora muito se fale em mudanças organizacionais, com ênfase na inclusão total e no desenvolvimento do ser humano, de concreto, muito pouco se tem praticado. Num cenário em que...

Opioid Prescribing PSA (:60)

Centers for Disease Control (CDC) Podcasts

This 60 second public service announcement is based on the July 2017 CDC Vital Signs report. Higher opioid prescribing puts patients at risk for addiction and overdose. Learn what can be done about this serious problem.

Information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing: a systematic review.

Directory of Open Access Journals (Sweden)

Geoffrey K Spurling

2010-10-01

analyses. Data were extracted independently by two authors and a narrative synthesis performed following the MOOSE guidelines. Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four found no association, and one found an association with lower costs. The narrative synthesis finding of variable results was supported by a meta-analysis of studies of prescribing frequency that found significant heterogeneity. The observational nature of most included studies is the main limitation of this review. CONCLUSIONS: With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. We did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies. Please see later in the article for the Editors' Summary.

Measuring the relationship between interruptions, multitasking and prescribing errors in an emergency department: a study protocol.

Science.gov (United States)

Raban, Magdalena Z; Walter, Scott R; Douglas, Heather E; Strumpman, Dana; Mackenzie, John; Westbrook, Johanna I

2015-10-13

Interruptions and multitasking are frequent in clinical settings, and have been shown in the cognitive psychology literature to affect performance, increasing the risk of error. However, comparatively less is known about their impact on errors in clinical work. This study will assess the relationship between prescribing errors, interruptions and multitasking in an emergency department (ED) using direct observations and chart review. The study will be conducted in an ED of a 440-bed teaching hospital in Sydney, Australia. Doctors will be shadowed at proximity by observers for 2 h time intervals while they are working on day shift (between 0800 and 1800). Time stamped data on tasks, interruptions and multitasking will be recorded on a handheld computer using the validated Work Observation Method by Activity Timing (WOMBAT) tool. The prompts leading to interruptions and multitasking will also be recorded. When doctors prescribe medication, type of chart and chart sections written on, along with the patient's medical record number (MRN) will be recorded. A clinical pharmacist will access patient records and assess the medication orders for prescribing errors. The prescribing error rate will be calculated per prescribing task and is defined as the number of errors divided by the number of medication orders written during the prescribing task. The association between prescribing error rates, and rates of prompts, interruptions and multitasking will be assessed using statistical modelling. Ethics approval has been obtained from the hospital research ethics committee. Eligible doctors will be provided with written information sheets and written consent will be obtained if they agree to participate. Doctor details and MRNs will be kept separate from the data on prescribing errors, and will not appear in the final data set for analysis. Study results will be disseminated in publications and feedback to the ED. Published by the BMJ Publishing Group Limited. For permission

Prescribing patterns in premenstrual syndrome

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Jones Paul W

2002-06-01

Full Text Available Abstract Background Over 300 therapies have been proposed for premenstrual syndrome. To date there has been only one survey conducted in the UK of PMS treatments prescribed by GPs, a questionnaire-based study by the National Association of Premenstrual Syndrome in 1989. Since then, selective serotonin re-uptake inhibitors have been licensed for severe PMS/PMDD, and governmental recommendations to reduce the dosage of vitamin B6 (the first choice over-the-counter treatment for many women with PMS have been made. This study investigates the annual rates of diagnoses and prescribing patterns for premenstrual syndrome (1993–1998 within a computerised general practitioner database. Methods Retrospective survey of prescribing data for premenstrual syndrome between 1993–1998 using the General Practice Research Database for the West Midlands Region which contains information on 282,600 female patients Results Overall the proportion of women with a prescription-linked diagnosis of premenstrual syndrome has halved over the five years. Progestogens including progesterone were the most commonly recorded treatment for premenstrual syndrome during the whole study period accounting for over 40% of all prescriptions. Selective serotonin-reuptake inhibitors accounted for only 2% of the prescriptions in 1993 but rose to over 16% by 1998, becoming the second most commonly recorded treatment. Vitamin B6 accounted for 22% of the prescriptions in 1993 but dropped markedly between 1997 and 1998 to 11%. Conclusions This study shows a yearly decrease in the number of prescriptions linked to diagnoses for premenstrual syndrome. Progestogens including progesterone, is the most widely prescribed treatment for premenstrual syndrome despite the lack of evidence demonstrating their efficacy.

O ensino da escrita e o desenvolvimento das pessoas com deficiência intelectual

Directory of Open Access Journals (Sweden)

Solange Marques Rossato

2013-12-01

Full Text Available O presente artigo propõe uma reflexão teórica acerca do desenvolvimento das crianças com deficiência intelectual no que tange à importância e à necessidade de aprender a linguagem escrita, do ponto de vista da Teoria Histórico-Cultural. Para essa abordagem, o curso de desenvolvimento de uma criança, considerada deficiente ou não, ocorrerá conforme as condições culturais e sociais em que ela estiver inserida. Assim, no tocante à criança com deficiência intelectual, a sua condição cultural, em relação dinâmica com os entraves colocados por sua condição especial, será a fonte de seu desenvolvimento. Se o desenvolvimento das funções psicológicas superiores se realiza mediante o uso de ferramentas e se as pessoas com deficiência intelectual apresentam inaptidão para o uso dessas ferramentas, será necessário criar meios auxiliares para elas poderem aprender a utilizá-las, como meio de formar e desenvolver as suas funções psíquicas. Nesse processo, o ensino e a apropriação da linguagem escrita são vias fundamentais de acesso ao mundo cultural, numa mais ampla significação da comunicação, do mundo e de si mesmo. Em suma, os educadores compreenderem a relevância do ensino intencional da linguagem escrita e do processo histórico que a constitui representa uma contribuição fundamental para o processo de humanização das crianças com deficiência.

Sorafenib prescribed by gastroenterologists and hepatologists for hepatocellular carcinoma

Science.gov (United States)

Kaplan, David E.; Mehta, Rajni; D’Addeo, Kathryn; Valderrama, Adriana; Taddei, Tamar H.

2018-01-01

Abstract Sorafenib is the only Food and Drug Administration (FDA)-approved first-line therapy shown to have survival benefit for patients with advanced hepatocellular carcinoma (HCC). Patients with advanced HCC are often but not exclusively transferred from non-oncologists to oncologists to initiate systemic therapy. The objective of this study was to assess whether sorafenib prescribing by non-oncologists has any impact on utilization, adverse effects, cost or outcome. This was a retrospective cohort study utilizing data from patients prescribed sorafenib for HCC within Veterans Health Administration hospitals with 100% chart abstraction to confirm HCC diagnosis, identify prescribing provider specialty (oncology versus gastroenterology/hepatology), and obtain data required for cancer staging by the Barcelona Clinic Liver Cancer (BCLC) system. The primary outcome was overall survival from the time of sorafenib prescription. A total of 4903 patients who prescribed sorafenib for HCC were identified, for whom 340 patients (6.9%) were prescribed drug by a non-oncologist (Onc). BCLC Stage, age, Child–Turcotte–Pugh score, and comorbidity indices were similar between patients prescribed sorafenib by oncologists and non-oncologists. Oncologists more often discontinued sorafenib due to progression, whereas non-oncologists were more likely to continue sorafenib until death resulting in greater pill utilization and cost. Overall survival in both unadjusted and multivariable models showed no significant impact of prescriber type on survival (222 vs 217 days, P = .96), confirmed with propensity-matched subcohorts. Similar survival outcomes were observed for patients with HCC prescribed sorafenib by non-oncologists and oncologists, suggesting that non-oncologists with expertise in the management of HCC can safely and effectively administer sorafenib. PMID:29369224

The impact of a closed‐loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before‐and‐after study

Science.gov (United States)

Franklin, Bryony Dean; O'Grady, Kara; Donyai, Parastou; Jacklin, Ann; Barber, Nick

2007-01-01

Objectives To assess the impact of a closed‐loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants Before‐and‐after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention Closed‐loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results Prescribing errors were identified in 3.8% of 2450 medication orders pre‐intervention and 2.0% of 2353 orders afterwards (pMedical staff required 15 s to prescribe a regular inpatient drug pre‐intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre‐intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions A closed‐loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication‐related tasks increased. PMID:17693676

A aplicação do QFD no desenvolvimento de software: um estudo de caso

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Fernando Antônio Sonda

2000-06-01

Full Text Available Este trabalho tem como objetivo apresentar a aplicação do QFD como ferramenta de suporte para o planejamento e desenvolvimento de um software de custos, visando um melhor atendimento das características demandadas pelo cliente, bem como a determinação de indicadores para controlar o processo de desenvolvimento do produto. O trabalho foi desenvolvido a partir de uma pesquisa de mercado realizada com usuários de softwares de custos e demais pessoas envolvidas com o gerenciamento de custos. Com a aplicação do QFD, observou-se que a definição antecipada das características principais do sistema é fundamental para o desenvolvimento de um software. O QFD vem se somar as demais ferramentas de análise de sistemas proporcionando, simultaneamente, um desenvolvimento mais rápido e mais qualificado.This paper presents an application of QFD for planning and development of a cost software. The QFD was chosen aiming a better assessment of the user desires as well as the indication of the parameters for process control. The work was initiated from a market survey conducted on users of cost software and other people involved in cost management. The use of the QFD shows that the early definition of the key characteristics of the system is essential in software development. The QFD complements the use of other system analysis techniques and contributes for a faster and more qualified software development.

Prescribed burning experiences in Italy: an integrated approach to prevent forest fires

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Ascoli D

2012-02-01

Full Text Available Prescribed burning is used in many geographical areas for multiple and integrated objectives (wildfire prevention, habitat conservation, grazing management. In Europe the collaboration between researchers and fire professionals has brought to implement this technique over increasing areas (~104 ha year-1, effectively and efficiently. In Italy prescribed burning has not been much studied and it is rarely applied. A new interest is recently rising. Some Regions particularly threatened by wildfires have updated their legislation and set up procedures to authorize prescribed fire experiments and interventions. From 2004 to 2011 several scientific, operative and training experiences have been carried out at a regional level (Basilicata, Campania, Friuli Venezia Giulia, Piemonte, Sardegna, Toscana. The present paper aims to: (i document and compare these regional programs; (ii discuss their frameworks and limitations; (iii provide information about objectives, prescriptions, methods and results. The study has involved Universities, Forest Corps, Civil Protection, Municipalities, Parks and professionals from Italy and other Countries. Interventions have regarded integrated objectives (fire hazard reduction; habitat conservation; forest and grazing management, and involved several vegetation types (broadleaved and conifer forests; Mediterranean and Continental shrublands; grasslands. Studies on fire behaviour and ecology have helped to set prescriptions for specific objectives and environments. Results have been transferred to professionals through training sessions. Several common elements are outlined: integrated objectives, multidisciplinary character, training and research products. Ecological questions, certification to the use of fire, communication to local communities and the proposal of new studies, are some of the issues outlined in the discussion. The present study is the first review at national level and we hope it will help to deepen the

Restrição protéica in utero : desenvolvimento sexual e histofisiologia do sistema reprodutivo de ratos machos

OpenAIRE

Fabiola Choqueta Tolêdo

2010-01-01

Resumo: Nos últimos anos vem aumentando o reconhecimento mundial sobre a relevância da nutrição como pilar básico para o desenvolvimento econômico e social. Em países em desenvolvimento como o Brasil, por exemplo, a desnutrição é um problema sócio-econômico causado pela má alimentação e pela baixa renda. O nascimento de crianças com baixo peso é reconhecido como um importante problema de saúde pública, com efeitos devastadores no desenvolvimento, na sobrevivência e na saúde humana. Milhares d...

Antimicrobial prescribing behaviour in dogs and cats by Belgian veterinarians.

Science.gov (United States)

Van Cleven, Alexia; Sarrazin, Steven; de Rooster, Hilde; Paepe, Dominique; Van der Meeren, Sofie; Dewulf, Jeroen

2018-03-17

The objective of this study is to survey general prescribing behaviour by Belgian companion animal veterinarians and to assess agreement of these practices with current treatment guidelines. Therefore an online survey was administered with five realistic and frequently occurring first-line cases to primary-care veterinary practitioners. For each case a predefined pattern of questions were asked about whether or not they would prescribe antimicrobials, if they would prescribe a non-antimicrobial treatment and if they would perform additional diagnostic steps. The responses were compared with recommendations in national guidelines and recent literature. The overall most prescribed antimicrobials were potentiated amoxicillin (43.0 per cent), fluoroquinolones (14.7 per cent), third-generation and fourth-generation cephalosporins (10.9 per cent) and tetracyclines (10.9 per cent). Only 48.3 per cent of the veterinarians complied with the guidelines in nearly all of the clinical scenarios (ie, prescribing antimicrobials when indicated, not prescribing antimicrobials when it is not indicated). Moreover, when prescribing highest priority critically important antimicrobials, susceptibility testing on bacterial cultures was performed in only 12.4 per cent of the prescriptions. The results showed that the prescribing behaviour of antimicrobial compounds by primary-care veterinary practitioners in dogs and cats is often not in agreement with national guidelines. Focus in improvement of this prescribing behaviour should be on performing the appropriate diagnostic steps and decreasing the use of highest priority critically important antimicrobials. © British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Desenvolvimento de hardware reconfigurável de criptografia assimétrica

Directory of Open Access Journals (Sweden)

Otávio Souza Martins Gomes

2015-01-01

Full Text Available Este artigo apresenta o resultado parcial do desenvolvimento de uma interface de hardware reconfigurável para criptografia assimétrica que permite a troca segura de dados. Hardwares reconfiguráveis permitem o desenvolvimento deste tipo de dispositivo com segurança e flexibilidade e possibilitam a mudança de características no projeto com baixo custo e de forma rápida.Palavras-chave: Criptografia. Hardware. ElGamal. FPGA. Segurança. Development of an asymmetric cryptography reconfigurable harwadre ABSTRACTThis paper presents some conclusions and choices about the development of an asymmetric cryptography reconfigurable hardware interface to allow a safe data communication. Reconfigurable hardwares allows the development of this kind of device with safety and flexibility, and offer the possibility to change some features with low cost and in a fast way.Keywords: Cryptography. Hardware. ElGamal. FPGAs. Security.

Investimentos diretos estrangeiros e políticas de desenvolvimento

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Antônio Corrêa de Lacerda

2008-05-01

Full Text Available O artigo discute alternativas para a inserção internacional da economia brasileira, especialmente no que se refere ao papel dos investimentos diretos estrangeiros, da geração de valor agregado local e do desempenho das exportações, a partir do cenário da globalização e suas transformações. Na primeira parte analisa-se a competitividade dos países em desenvolvimento e, na segunda parte, discutem-se estratégias de política econômica para uma inserção internacional mais ativa na economia brasileira. Palavras-chave: investimentos diretos estrangeiros; globalização; inserção externa; políticas de desenvolvimento. Abstract The article discusses alternatives for the international insertion of Brazilian economy especially considering the role of foreign direct investments, the creation of local aggregated value and the exportations performance from the scene of the globalization and its transformations. In the first part, the competitiveness of developing countries is analyzed and in the second part, strategies of economic policy for a more active international of Brazilian economy are discussed. Keywords: foreign direct investments, globalization, international insertion, development policies.

Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation.

Science.gov (United States)

Mills, Pamela Ruth; Weidmann, Anita Elaine; Stewart, Derek

2017-12-01

Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation

Quality Improvement Initiative to Decrease Variability of Emergency Physician Opioid Analgesic Prescribing

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John H. Burton

2016-05-01

Full Text Available Introduction: Addressing pain is a crucial aspect of emergency medicine. Prescription opioids are commonly prescribed for moderate to severe pain in the emergency department (ED; unfortunately, prescribing practices are variable. High variability of opioid prescribing decisions suggests a lack of consensus and an opportunity to improve care. This quality improvement (QI initiative aimed to reduce variability in ED opioid analgesic prescribing. Methods: We evaluated the impact of a three-part QI initiative on ED opioid prescribing by physicians at seven sites. Stage 1: Retrospective baseline period (nine months. Stage 2: Physicians were informed that opioid prescribing information would be prospectively collected and feedback on their prescribing and that of the group would be shared at the end of the stage (three months. Stage 3: After physicians received their individual opioid prescribing data with blinded comparison to the group means (from Stage 2 they were informed that individual prescribing data would be unblinded and shared with the group after three months. The primary outcome was variability of the standard error of the mean and standard deviation of the opioid prescribing rate (defined as number of patients discharged with an opioid divided by total number of discharges for each provider. Secondary observations included mean quantity of pills per opioid prescription, and overall frequency of opioid prescribing. Results: The study group included 47 physicians with 149,884 ED patient encounters. The variability in prescribing decreased through each stage of the initiative as represented by the distributions for the opioid prescribing rate: Stage 1 mean 20%; Stage 2 mean 13% (46% reduction, p<0.01, and Stage 3 mean 8% (60% reduction, p<0.01. The mean quantity of pills prescribed per prescription was 16 pills in Stage 1, 14 pills in Stage 2 (18% reduction, p<0.01, and 13 pills in Stage 3 (18% reduction, p<0.01. The group mean

A PERCEPÇÃO DO DESENVOLVIMENTO REGIONAL NA GRANDE FRONTEIRA DO MERCOSUL

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Jandir Ferrera de Lima

2012-09-01

Full Text Available Este artigo analisa a percepção do desenvolvimento regional na opinião das lideranças do Fórum da região Grande Fronteira do Mercosul (GFM no Sul do Brasil. A região GFM enfrenta dificuldades em manter seu dinamismo econômico frente ao contexto de globalização, da competitividade dos mercados, das dificuldades das pequenas propriedades rurais e as precárias condições sociais de parcela significativa da sua população. Para as lideranças do Fórum da GFM, o desenvolvimento regional implica na melhoria dos indicadores econômicos e sociais e na ação coordenada da sociedade civil organizada através dos órgãos de governança local.

Benefits of nurse prescribing for patients in pain: nurses' views.

Science.gov (United States)

Stenner, Karen; Courtenay, Molly

2008-07-01

This paper is a report of a study to explore nurses' views on the benefits of adopting the role of prescribing for patients with acute and chronic pain. It was envisioned that the advent of nurse prescribing would be beneficial to the efficiency and effectiveness of the United Kingdom National Health Service. Research to date does indeed indicate that nurse prescribing can be beneficial to patients, nurses and the health service in general. Despite the expansion of nurse prescribing, there is little evidence of its impact according to nurses working in specialist areas, such as with patients in acute and chronic pain. Interviews were conducted during 2006 and 2007 with 26 nurses qualified to prescribe medicines for patients in acute and chronic pain. This was a qualitative study and a thematic analysis was conducted. Nurses reported a number of benefits, including faster access to treatment, improved quality of care, more appropriate prescribing of medication, improved safety, improved relations and communication with patients, greater efficiency and cost effectiveness. Nurses benefited from increased job satisfaction, credibility with patients and healthcare professionals and also gained knowledge through prescribing. There is potential for the benefits of nurse prescribing to be expanded beyond the United Kingdom in settings where nurses hold similar roles in the treatment of pain, although further research using a wider range of research methods is recommended to substantiate these findings.

Deficiência Visual, Interação e Desenvolvimento da Linguagem

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Fabiana Kaodoinski

2017-06-01

Full Text Available Este trabalho pretende refletir sobre a importância da interação de crianças cegas congênitas com os objetos de conhecimento, com o espaço e com o outro para a promoção da aprendizagem e para o desenvolvimento do pensamento e da linguagem do indivíduo com essa deficiência. Nesse estudo teórico, entende-se a relação intersubjetiva como constitutiva do eu, conforme postulados benvenistianos. Além disso, considerando a premissa de Leonhardt (1992 de que a visão é responsável por integrar e organizar a experiência proveniente dos outros sentidos, destaca-se que o cego, por não dispor da percepção visual, pode ter dificuldades de formar conceitos – segundo pressupostos de Vygotski. Diante disso, busca-se explicitar, com base em estudos de Autor, a complexidade inerente à configuração da relação enunciativa “eu-tu” no processo de formação de conceitos em crianças com cegueira congênita, destacando-se a necessidade da constante mediação do cuidador para a promoção do desenvolvimento da cognição e da linguagem. A partir deste estudo, foi possível perceber que há um processo sistêmico no desenvolvimento do cego congênito, ou seja, linguagem, pensamento, cognição e interação estão interligados e são indissociáveis.

Computational opioid prescribing: a novel application of clinical pharmacokinetics.

Science.gov (United States)

Linares, Oscar A; Linares, Annemarie L

2011-01-01

We implemented a pharmacokinetics-based mathematical modeling technique using algebra to assist prescribers with point-of-care opioid dosing. We call this technique computational opioid prescribing (COP). Because population pharmacokinetic parameter values are needed to estimate drug dosing regimen designs for individual patients using COP, and those values are not readily available to prescribers because they exist scattered in the vast pharmacology literature, we estimated the population pharmacokinetic parameter values for 12 commonly prescribed opioids from various sources using the bootstrap resampling technique. Our results show that opioid dosing regimen design, evaluation, and modification is feasible using COP. We conclude that COP is a new technique for the quantitative assessment of opioid dosing regimen design evaluation and adjustment, which may help prescribers to manage acute and chronic pain at the point-of-care. Potential benefits include opioid dose optimization and minimization of adverse opioid drug events, leading to potential improvement in patient treatment outcomes and safety.

Characteristics of prescribers whose patients shop for opioids: results from a cohort study.

Science.gov (United States)

Cepeda, M Soledad; Fife, Daniel; Berlin, Jesse A; Mastrogiovanni, Gregory; Yuan, Yingli

2012-01-01

Little is known about the prevalence of opioid shoppers in clinical practices and the relation between prescriber characteristics and the risk of having opioid shoppers. Describe the prevalence of opioid shoppers in prescribers' practices. Assess the relation between prescribers' characteristics and patient opioid shopping behavior. Retrospective cohort study using a large US retail prescription database. Patients with ≥1 opioid dispensing were followed 18 months. These patients' prescribers are the focus of the study. A patient was a "shopper" if he or she had opioid prescriptions written by ≥1 prescriber with ≥1 day of overlap filled at ≥3 pharmacies and a "heavy shopper" if he or she had ≥5 shopping episodes. The proportions of shoppers by prescriber and the proportion of prescribers with ≥1 shopper or heavy shopper were calculated. Among 858,290 opioid prescribers, most (87 percent) had no shoppers and 98 percent had no heavy shoppers. Prescribers who were aged 70-79 years, male, or who prescribed schedule II opioids had an increased likelihood of having shoppers. As the number of patients for whom a prescriber prescribed opioids increased, the proportion of shoppers also increased. Prescribers with 66 or more patients receiving opioids, who represented 25 percent of prescribers, prescribed for 82 percent of all shoppers. The great majority of opioid prescribers appear to have no shoppers in their practice. Any educational program will be more cost effective if targeted to prescribers of schedule II opioids with a large volume of patients requiring opioids.

12 CFR 747.13 - Change of time limits.

Science.gov (United States)

2010-01-01

... ADMINISTRATIVE ACTIONS, ADJUDICATIVE HEARINGS, RULES OF PRACTICE AND PROCEDURE, AND INVESTIGATIONS Uniform Rules of Practice and Procedure § 747.13 Change of time limits. Except as otherwise provided by law, the administrative law judge may, for good cause shown, extend the time limits prescribed by the Uniform Rules or by...

Desenvolvimento da linguagem na clínica fonoaudiológica em uma perspectiva multimodal

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Ivonaldo Leidson Barbosa Lima

2015-12-01

Full Text Available A aquisição da linguagem contempla um processo dialógico contínuo de desenvolvimento mútuo da fala, dos gestos, do olhar que se (interrelacionam e constituem um único conjunto de produção e de significação. Essa concepção de linguagem multimodal começa a penetrar, atualmente, na prática fonoaudiológica, que busca promover atenção à saúde da comunicação humana. Desse modo, este trabalho buscou analisar o desenvolvimento linguístico, em uma perspectiva multimodal, de uma criança com atraso nesse processo de apropriação da linguagem. Para isso, foram realizadas filmagens de três encontros terapêuticos entre uma díade criança-fonoaudiólogo e foi analisada uma atividade comum nessas sessões: uma brincadeira com um jogo de animais. Constatou-se que há uma integração entre o uso de gestos e da fala, principalmente em partes que atraem mais a atenção da criança. Além disso, houve um desenvolvimento das produções verbais característica da trajetória infantil: na avaliação fonoaudiológica, foi observado que o menino só balbuciava, mais, durante o processo terapêutico, verificou-se o surgimento do uso de jargões e das primeiras palavras reconhecíveis e interpretáveis pelo adulto. Acredita-se que esse desenvolvimento tenha sido favorecido pela terapia fonoaudiológica em parceria à estimulação familiar.

Antibiotics for URTI and UTI -- prescribing in Malaysian primary care settings.

Science.gov (United States)

Teng, Cheong Lieng; Tong, Seng Fah; Khoo, Ee Ming; Lee, Verna; Zailinawati, Abu Hassan; Mimi, Omar; Chen, Wei Seng; Nordin, Salleh

2011-05-01

Overprescription of antibiotics is a continuing problem in primary care. This study aims to assess the antibiotic prescribing rates and antibiotic choices for upper respiratory tract infections (URTI) and urinary tract infections (UTI) in Malaysian primary care. Antibiotic prescribing data for URTI and UTI was extracted from a morbidity survey of randomly selected primary care clinics in Malaysia. Analysis was performed of 1,163 URTI and 105 UTI encounters. Antibiotic prescribing rates for URTI and UTI were 33.8% and 57.1% respectively. Antibiotic prescribing rates were higher in private clinics compared to public clinics for URTI, but not for UTI. In URTI encounters, the majority of antibiotics prescribed were penicillins and macrolides, but penicillin V was notably underused. In UTI encounters, the antibiotics prescribed were predominantly penicillins or cotrimoxazole. Greater effort is needed to bring about evidence based antibiotic prescribing in Malaysian primary care, especially for URTIs in private clinics.

Non-medical prescribing of chemotherapy: engaging stakeholders to maximise success?

Science.gov (United States)

Lennan, Elaine

2014-01-01

This study report examines the views and experiences of professional stakeholders about non-medical prescribing (NMP) of chemotherapy. The introduction of open formulary NMP has created opportunities to radically change health-care delivery. For chemotherapy services, the most recent advice from the National Chemotherapy Advisory Group [Department of Health (2009) Chemotherapy Services in England, ensuring quality and safety: a report from the National Chemotherapy Advisory Group, London Her Majesty's Stationary Office] clearly endorses the development of nurse- or pharmacist-led chemotherapy clinics. This is very much welcomed but is based on very limited evidence as to their effectiveness. A fourth-generation evaluation study. A purposeful sample of 23 stakeholders connected with the chemotherapy service was used. A serial data collection technique with individual interviews followed by uni-professional focus groups was adopted. Finally, a multi-professional focus group was held to determine the strategic way forward. Data were collected in 2009-2010. The study illuminated the key features necessary to maximise success of NMP in chemotherapy clinics and captures the importance of good working relationships. Whilst different practice models will emerge, fundamental and core to services is the need for good team working, established and effective communication strategies, and most importantly avoiding isolation in practice. This study additionally reinforced any evaluation takes place within preexisting political contexts and in particular medical dominance. Not all medical colleagues agreed with or wanted NMP for their patients, highlighting difficulties of developing new models of working within a resisting culture. No objections to NMP of chemotherapy were found, but, clearly, the context of practice needs to be agreed and supportedby all professional stakeholders. What is already known about this topicOpen formulary non-medical prescribing has been rapidly

The pharmacist as prescriber: a discourse analysis of newspaper media in Canada.

Science.gov (United States)

Schindel, Theresa J; Given, Lisa M

2013-01-01

Legislation to expand the scope of practice for pharmacists to include authority to independently prescribe medications in Alberta, Canada was announced in 2006 and enacted in April 2007. To date, very little research has explored public views of pharmacist prescribing. This study analyzes newspaper media coverage of pharmacist prescribing 1 year before and 2 years after prescribing was implemented. News items related to pharmacist prescribing were retrieved from 2 national, Canadian newspapers and 5 local newspapers in Alberta over a 3-year period after the announcement of pharmacist prescribing. A purposive sample of 66 texts including news items, editorials, and letters were retrieved electronically from 2 databases, Newscan and Canadian Newsstand. This study uses social positioning theory as a lens for analyzing the discourse of pharmacist prescribing. The results demonstrate a binary positioning of the debate on pharmacist prescribing rights. Using social positioning theory as a lens for analysis, the results illustrate self- and other-positioning of pharmacists' expected roles as prescribers. Themes related to the discourse on pharmacist prescribing include qualifications, diagnosis, patient safety, physician support, and conflict of interest. Media representations of pharmacist prescribing point to polarized views that may serve to shape public, pharmacist, physician, and others' opinions of the issue. Multiple and contradictory views of pharmacist prescribing coexist. Pharmacists and pharmacy organizations are challenged to bring clarity and consistency about pharmacist prescribing to better serve the public interest in understanding options for health care services. Copyright © 2013 Elsevier Inc. All rights reserved.

O desenvolvimento corporal na educação infantil

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Adriana Pacheco da Silva Santos

2011-12-01

Full Text Available Este artigo é resultado de um estudo realizado em uma creche pública pertencente à rede municipal de educação de Sinop - MT. Objetivamos compreender o movimento corporal das crianças como parte do desenvolvimento integral das crianças. E também entender como os profissionais trabalham a especificidade do corpo infantil, dos movimentos das crianças durante a rotina da instituição de uma turma de crianças de dois a três anos de idade. Optamos em focalizar a pesquisa na área da Educação Infantil por entender que as crianças desta faixa etária apresentam características importantes no desenvolvimento corporal, visto que muitas vezes na educação infantil o movimento é considerado como ‘indisciplina’, fazendo com que a criança, na maioria das vezes permanece quietas e sentadas em suas cadeiras. Diante de tal propósito, buscamos uma metodologia que nos possibilitasse apreender o movimento corporal da criança e encontramos na pesquisa qualitativa, através da ‘observação participante’, trilhas que nos conduziram à construção de conhecimentos. Como pesquisadora, permanecemos na instituição investigada por quase três meses, em horários intercalados, utilizando o caderno de campo, no qual registramos as observações realizadas, bem como as entrevistas com as professoras da referida turma. Os principais referenciais utilizados para o estudo foram: Vygotsky, Piaget, Vitor Fonseca e Henri Wallon. De acordo com o observado em campo e leituras teóricas, ressaltamos com este estudo a importância do movimento para as crianças e sua contribuição no desenvolvimento infantil pleno.Palavras-chave: educação; educação infantil; maternal II; movimento; sociointeracionismo.

Inappropriate prescribing and prescribing omissions among drug-related problems using STOPP-START criteria

NARCIS (Netherlands)

Verdoorn, M.A.; Kwint, H.-F.; Faber, A.; L. Bouvy, M.

2013-01-01

Background and objectives: Medication review has been suggested as a way to prevent drug related problems (DRPs). Screening tools have been formulated to identify potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) respectively called Screening Tool of Older

A 5-year retrospective audit of prescribing by a critical care outreach team.

Science.gov (United States)

Wilson, Mark

2018-05-01

UK prescribing legislation changes made in 2006 and 2012 enabled appropriately qualified nurses to prescribe any licensed medication, and all controlled drugs in schedule 2-5 of the Misuse of Drugs Regulations 2001, for any medical condition within their clinical competence. Critical Care Outreach nurses who are independent nurse prescribers are ideally placed to ensure that acutely ill patients receive treatment without delay. The perceived challenge was how Critical Care Outreach nurses would be able to safely prescribe for a diverse patient group. This study informs this developing area of nurse prescribing in critical care practice. The aims of the audit were to: identify which medications were prescribed; develop a critical care outreach formulary; identify the frequency, timing and number of prescribing decisions being made; identify if prescribing practice changed over the years and provide information for our continuing professional development. This article reports on data collected from a 5-year retrospective audit; of prescribing activity undertaken by nine independent nurse prescribers working in a 24/7 Critical Care Outreach team of a 600-bedded district general hospital in the UK. In total, 8216 medication items were prescribed, with an average of 2·6 prescribed per shift. The most commonly prescribed items were intravenous fluids and analgesia, which were mostly prescribed at night and weekends. The audit has shown that Critical Care Outreach nurse prescribing is feasible in a whole hospital patient population. The majority of prescribing occurred after 16:00 and at night. Further research would be beneficial, particularly looking at patient outcomes following reviews from prescribing critical care outreach nurses. The audit is one of the only long-term studies that describes prescribing practice in Critical Care Outreach teams in the UK. © 2017 British Association of Critical Care Nurses.

Rastreio do desenvolvimento psicomotor: influência dos fatores de risco e contributo da psicomotricidade

OpenAIRE

Afonso, Carla Sandra Carneiro

2015-01-01

Tese de Doutoramento em Ciências do Desporto O desenvolvimento psicomotor é um processo dinâmico e contínuo que resulta das transformações que vão ocorrendo no ser humano ao longo da sua vida, e que depende da inter-relação entre os fatores genéticos e ambientais. Para se proceder à verificação e avaliação do desenvolvimento, é necessária a utilização de testes válidos, práticos e precisos que nos permitam obter resultados fidedignos, essenciais para que a criança cumpra em ...

O desenvolvimento enquanto apropriação dos direitos humanos

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Ignacy Sachs

1998-08-01

Full Text Available O DESENVOLVIMENTO considerado em seus aspectos pluridimensionais e a democratização entendida como expansão de liberdades positivas, apropriação efetiva de todos os direitos humanos e universalização da cidadania são apenas duas facetas do mesmo processo histórico. A história assim como a teoria do desenvolvimento deveriam ser re-formuladas em seus conceitos segundo essa visão. Seria possível construir um relato da condição humana do cidadão usando-se como ponto de referência a apropriação de direitos escolhidos por diferentes grupos sociais.DEVELOPMENT considered is its pluridimensionality and democratization understood as expansion of positive freedoms, effective appropriation of all human rights and universalization of citizenship are but two facets of the same historical process. Both the history and the theory of development should be reconceptualized accordingly. A citizen report on human condition could be built using as entry-points the appropriation of selected rights by different social groups.

Entrevista de Crianças e Adolescentes em Contexto Policial e Forense: Uma Perspectiva do Desenvolvimento

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Rui Paulo

2015-09-01

Full Text Available Conhecer as diferentes etapas do desenvolvimento humano é uma competência essencial para o entrevistador em contexto policial e forense. É imprescindível adaptar a entrevista em função da avaliação das competências da testemunha. Este artigo caracteriza as etapas do desenvolvimento humano ao longo da infância e adolescência, destacando o desenvolvimento da memória e outras competências relevantes para a entrevista de testemunhas. Analisou-se ainda a adequabilidade de várias metodologias utilizadas para este fim, salientando algumas diretrizes fundamentais para a condução de uma boa entrevista. Por fim, focou-se na Entrevista Cognitiva Melhorada enquanto técnica promissora para entrevistar crianças e adolescentes. Pretende-se não apenas rever de forma crítica a literatura existente, mas também construir um guia para os profissionais desta área.

DA QUEDA DO MODELO DE DESENVOLVIMENTO FORDISTA À ASCENSÃO DA ACUMULAÇÃO FLEXÍVEL

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Francisco José Lima Sales

2017-03-01

Full Text Available O texto aborda a problemática apresentada pelas profundas transformações ocorridas no mundo do trabalho e na estrutura do Estado regulador, voltado para o bem-estar social. Objetiva discutir o processo de reestruturação produtiva capitalista, ocorrido a partir das últimas décadas do século passado, e as suas conseqüências sobre o modelo de desenvolvimento à época dominante, o fordismo. Para caracterizar a crise do modelo de desenvolvimento fordista, são utilizados aspectos da perspectiva adotada pela escola francesa da regulação, com destaque das principais características deste modelo que emergiu no pós-guerra e que adquiriu configuração mundial no ocidente industrializado, e, principalmente, do processo de reestruturação industrial que ocorreu no âmbito das economias centrais e as características do novo modelo de desenvolvimento.

Can we influence prescribing patterns?

Science.gov (United States)

Sbarbaro, J A

2001-09-15

A variety of programming techniques and methods of training have been employed to change physician behavior. Didactic continuing medical education lectures and clinical guidelines have had minimal impact, although endorsement of national professional guidelines by local opinion leaders appears to have a positive influence on the impact of professional guidelines. Interactive, hands-on workshops, performance reporting, and peer/patient feedback are also effective. Changing prescribing habits has been equally difficult. Drug utilization letters involving both pharmacist and physician have more impact than do letters sent only to the physician. Academic detailing, when properly executed, has been consistently effective. When combined with these strategies, closed formularies become a powerful tool in changing prescribing behavior.

Prescribed burning supports grassland biodiversity - A multi-species study

Science.gov (United States)

Valkó, Orsolya; Deák, Balázs; Magura, Tibor; Török, Péter; Kelemen, András; Tóth, Katalin; Horváth, Roland; Nagy, Dávid; Debnár, Zsuzsanna; Zsigrai, György; Kapocsi, István; Tóthmérész, Béla

2017-04-01

During ancient times, fire was an important factor shaping European landscapes. Nowadays, prescribed burning can be one of the most effective conservation tools for the management of open landscapes, controlling dominant species, reducing accumulated litter or decreasing wildfire risk. In a prescribed burning experiment, we studied the effects of fire on dry alkaline grasslands. We tested whether autumn prescribed burning can be an alternative conservation measure in these grasslands. We selected six sites in Hungary: in three sites, prescribed burning was applied in November 2011, while three sites remained unburnt. We studied the effects of fire on soil characteristics, plant biomass and on the vegetation and arthropod assemblages (isopods, spiders, ground beetles and rove beetles). Soluble salt content increased significantly in the burnt sites, but soil pH, organic matter, potassium and phosphorous did not change. We found that prescribed fire had several positive effects from the nature conservation viewpoint. Diversity and the number of flowering shoots were higher, and the cover of the dominant grass was lower in the burnt sites. Graminoid biomass was lower, while total, green and forb biomass were higher in the burnt plots compared to the control ones. Our findings suggest that prescribed burning fire did not harm arthropods; species-level analyses showed that out of the most abundant invertebrate species, the abundance of ten was not affected, one decreased and one increased after burning. Our findings highlight that mosaic prescribed fire is a viable management tool in open landscapes, because it supports plant diversity and does not threaten arthropods.

Advantages and disadvantages of interdisciplinary consultation in the prescription of assistive technologies for mobility limitations.

Science.gov (United States)

de Laat, Fred A; van Heerebeek, Bart; van Netten, Jaap J

2018-03-28

To explore the advantages and disadvantages experienced by professionals in interdisciplinary consultation involving the user, prescriber and technician in the prescription of assistive technologies for mobility limitations. Cross-sectional study. Prescribers (N = 39) and orthopaedic technicians (N = 50), who were regularly involved in an interdisciplinary consultation completed a questionnaire about advantages and disadvantages of the interdisciplinary consultation. Advantages of the interdisciplinary consultation were mentioned within all CanMEDS areas of medical practice, including better and quicker prescription of the assistive technology, shared knowledge of medical diagnosis and device possibilities, shared decision making of the device prescription and clear communication rules. Disadvantages were mentioned in the CanMEDS areas management and collaboration, including planning problems (financial) reimbursement of this type of consultation, and time efficiency. On a 10-point scale, mean (standard deviation) rates of interdisciplinary consultations were 7.9 (0.6) according to prescribers, and 7.8 (0.9) by technicians. All participants wanted to continue the interdisciplinary consultation. Prescribers and technicians in the field of assistive technologies for walking mobility limitations appreciate an interdisciplinary consultation. Advantages are found in all CanMEDS areas, whereas disadvantages only concern coordination. It should be encouraged to realize this kind of consultation in all situations where such technologies are prescribed. Implications for rehabilitation Interdisciplinary consultation involving the user, prescriber and technician to prescribe assistive technologies for mobility limitations has many advantages in all CanMEDS areas of medical practice, and few disadvantages, related to management and collaboration only. The disadvantages of interdisciplinary consultation, such as (financial) reimbursement by health insurance companies

12 CFR 263.13 - Change of time limits.

Science.gov (United States)

2010-01-01

... RULES OF PRACTICE FOR HEARINGS Uniform Rules of Practice and Procedure § 263.13 Change of time limits. Except as otherwise provided by law, the administrative law judge may, for good cause shown, extend the time limits prescribed by the Uniform Rules or by any notice or order issued in the proceedings. After...

12 CFR 509.13 - Change of time limits.

Science.gov (United States)

2010-01-01

... PROCEDURE IN ADJUDICATORY PROCEEDINGS Uniform Rules of Practice and Procedure § 509.13 Change of time limits. Except as otherwise provided by law, the administrative law judge may, for good cause shown, extend the time limits prescribed by the Uniform Rules or any notice or order issued in the proceedings. After the...

12 CFR 19.13 - Change of time limits.

Science.gov (United States)

2010-01-01

... PROCEDURE Uniform Rules of Practice and Procedure § 19.13 Change of time limits. Except as otherwise provided by law, the administrative law judge may, for good cause shown, extend the time limits prescribed by the Uniform Rules or by any notice or order issued in the proceedings. After the referral of the...

Forum: Psychotropic prescribing in HIV | Reid | Southern African ...

African Journals Online (AJOL)

We provide a brief guide to the diagnosis and treatment of common mental disorders in people living with HIV/AIDS, including: prescribing psychotropics in HIV; neuropsychiatric side-effects of ARVs and other medications commonly prescribed in HIV; and the diagnosis and treatment of depression, anxiety, psychosis, ...

Desenvolvimento vegetativo de pinhão-manso em diferentes arranjos de plantio em sistemas agrossilvipastoris

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Marcelo Dias Müller

2014-07-01

Full Text Available O objetivo deste trabalho foi avaliar o efeito de diferentes arranjos de plantio no desenvolvimento vegetativo de plantas de pinhão-manso estabelecidas em dois tipos de consórcio agrossilvipastoril. O experimento foi realizado no Município de Coronel Pacheco, MG, em delineamento de blocos ao acaso, em arranjo de parcelas subdivididas. A parcela foi representada por cinco espaçamentos: 6x3 m (555 plantas por hectare, 12x(2x2 m (714 plantas por hectare, 10x(2x2 m (833 plantas por hectare, 8x(2x2 m (1.000 plantas por hectare e 6x1,5 m (1.111 plantas por hectare; e a subparcela, por dois tipos de consórcio: agrossilvipastoril (integração lavoura-pecuária-pinhão-manso e silvipastoril (integração pecuária-pinhão-manso. As avalições foram realizadas nas safras 2010/2011 e 2011/2012. O espaçamento de plantio de 6x3 m proporcionou maior desenvolvimento em diâmetro de copa e número de brotações das plantas de pinhão-manso, na safra 2010/2011. Na safra 2011/2012, foi observado maior desenvolvimento em altura com o espaçamento de plantio de 8x(2x2 m. O consórcio de pinhão-manso x milho x pastagem proporciona maior desenvolvimento das plantas de pinhão-manso para todas as variáveis estudadas nas duas safras.

Prescribing for pain--how do nurses contribute? A national questionnaire survey.

Science.gov (United States)

Stenner, Karen; Carey, Nicola; Courtenay, Molly

2012-12-01

To provide information on the profile and practice of nurses in the UK who prescribe medication for pain. Pain is widely under-reported and under-treated and can have negative consequences for health and psychosocial well-being. Indications are that nurses can improve treatment and access to pain medications when they prescribe. Whilst nurses working in many practice areas treat patients with pain, little is known about the profile, prescribing practice or training needs of these nurses. A descriptive questionnaire survey. An online questionnaire was used to survey 214 nurses who prescribed for pain in the UK between May and July 2010. Data were analysed using descriptive statistics and non-parametric tests. Half the participants (50%) worked in primary care, 32% in secondary care and 14% worked across care settings. A range of services were provided, including general practice, palliative care, pain management, emergency care, walk-in-centres and out-of-hours. The majority (86%) independently prescribed 1-20 items per week. Non-opioid and weak opioids analgesics were prescribed by most (95%) nurses, whereas fewer (35%) prescribed strong opioids. Training in pain had been undertaken by 97% and 82% felt adequately trained, although 28% had problems accessing training. Those with specialist training prescribed a wider range of pain medications, were more likely to prescribe strong opioids and were more often in pain management roles. Nurses prescribe for pain in a range of settings with an emphasis on the treatment of minor ailments and acute pain. A range of medications are prescribed, and most nurses have access to training. The nursing contribution to pain treatment must be acknowledged within initiatives to improve pain management. Access to ongoing training is required to support nurse development in this area of practice to maximise benefits. © 2012 Blackwell Publishing Ltd.

Improving health visitor emollient prescribing using a CQUIN-based approach.

Science.gov (United States)

Brooks, Christina; Khatau, Tejas

2015-12-01

Prescribing is an essential element of health visiting practice. This initiative used the payment framework of Commissioning for Quality and Innovation (CQUIN) to develop health visiting practice across a large health visiting workforce in the East Midlands. A focus on emollient prescribing practice was agreed and a guidance booklet regarding preferred emollient products was produced, based on the local formulary Each health visitor benefitted from receiving additional training and was given a guidance booklet to inform their practice. Targets were set for each quarter to demonstrate an improved prescribing adherence to the preferred product list.The targets were achieved for each quarter. Prescribing rates and confidence improved across the service. Therefore, it was demonstrated that specific guidance and ongoing support can improve prescribing practice within the health visiting service.

Potentially inappropriate prescribing in an Irish elderly population in primary care.

LENUS (Irish Health Repository)

Ryan, Cristín

2009-12-01

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers\\' criteria, Screening Tool of Older Persons\\' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.

A Importância da Criatividade no Desenvolvimento do Indivíduo

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Débora Martins

2012-09-01

Full Text Available Construído com o propósito de enfatizar a importância da criatividade para o desenvolvimento do indivíduo, este trabalho reflete sobre os diversos ambientes criativos (casa, escola e trabalho e sobre as influências dos seus intervenientes. Assim, é abordada neste estudo a criatividade, enquanto definição e conceito, o papel da família e da sua influência no percurso educativo e o ambiente criativo na escola e no mundo profissional. Posteriormente são apresentados estudos sobre a importância da criatividade na educação, e sobre o papel das disciplinas artísticas para o desenvolvimento criativo do indivíduo. Por último, são apresentados alguns casos de sucesso e empreendedorismo, que fundamentam a importância deste tema para o percurso profissional.

Dental students′ compliance with antibiotic prescribing guidelines for dental infections in children

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Yee Chen Wong

2016-01-01

Full Text Available Context: To investigate the antibiotic prescribing training received by dental students, clinical experience in treating child patients, awareness of antibiotic prescribing guidelines, preparedness in antibiotic prescribing, and compliance with antibiotic prescribing guidelines for the management of dental infections in children. Methods: This was a cross-sectional study involving final year dentals students from Malaysian and Asian dental schools. A self-administered questionnaire consisting of five clinical case scenarios was e-mailed to all final year students at selected dental schools. Students′ responses were compared for each clinical case scenario with the prescribing guidelines of the American Academy of Pediatric Dentistry and the American Dental Association. Compliance in each scenario was tested for association with their preparedness in antibiotic prescribing, previous training on antibiotic prescribing and awareness of antibiotic prescribing guidelines using Chi-square test. Data collected were analyzed using SPSS statistics version 20. Results: A total of 108 completed responses were received. About 74 (69% students were from Malaysian dental schools. The compliance rate with prescribing guidelines ranged from 15.7% to 43.5%. Those attending Malaysian dental schools (47.3% and those who had treated child patient more often (46.3% were more likely (P < 0.05 to be aware of the guidelines. Those who had received antibiotic prescribing training (21.3% were more likely to think they were well prepared in antibiotic prescribing (P < 0.05. Conclusions: Final year dental students had low awareness and compliance with antibiotic prescribing guidelines. Further research is needed to investigate how compliance with the guidelines may be enhanced.

Desenvolvimento de dispositivo de electroterapia para medicina física e reabilitação

OpenAIRE

Leitão, Cátia Sofia Jorge

2010-01-01

A electroterapia é uma das modalidades terapêuticas mais usadas em Medicina Física e Reabilitação. A presente dissertação assenta no desenvolvimento de um protótipo de dispositivo de aplicação de correntes eléctricas de baixa e média frequência. O objectivo principal é assim a recolha e especificação de requisitos técnicos e regulamentares para a concepção, desenvolvimento e prototipagem de equipamentos de electroterapia. A recolha de requisitos técnicos para desenvolver um dispositivo méd...

Processo de desenvolvimento das inovações na cadeia produtiva da maçã brasileira

OpenAIRE

Cruz, Marcia Rohr da

2013-01-01

A inovação exerce importância no negócio das empresas, compreende diferentes aspectos e contribui de formas diversas para o seu crescimento e desenvolvimento. Dentre os aspectos que podem ser levados em consideração para as inovações estão os aspectos internos relacionados com o contexto da organização e os aspectos externos que envolvem todo o ambiente em que a organização está inserida. Acredita-se que estes aspectos exercem influência tanto na decisão para o desenvolvimento das inovaçõ...

Desenvolvimento motor em crianças praticantes e não praticantes de atividades lúdicas aquáticas

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Lauana Priscila da Silva

2016-10-01

Full Text Available Entende-se como desenvolvimento motor a junção das características biológicas, meio ambiente e necessidades da tarefa. Sabe-se que é um processo permanente, o qual se inicia na concepção e só cessa com a morte do indivíduo. A estimulação diária das crianças pode acelerar e/ou melhorar esse desenvolvimento e, assim, as atividades lúdicas aquáticas se enquadram nessa estimulação, pois seu principal objetivo é a adaptação ao meio liquido, através do uso de brincadeiras, respeitando sempre o desenvolvimento motor de cada fase. O objetivo deste estudo foi avaliar o impacto da prática de atividades lúdicas aquáticas no desenvolvimento neuropsicomotor (DNPM de crianças entre 5 a 6 anos de idade. A amostra foi dividida em dois grupos, um de crianças praticantes e outro de crianças não praticantes de atividades lúdicas aquáticas. Ambos os grupos foram avaliados com a Escala de Desenvolvimento Motor (EDM sendo observado que o desempenho motor de ambos os grupos encontram-se dentro da normalidade esperada para as idades. Porém, a escassez de estudos com essa população sugere a necessidade de novos trabalhos investigativos sobre o assunto.

Exploração e desenvolvimento vocacional de jovens

OpenAIRE

Taveira, Maria do Céu

2000-01-01

Livro que apresenta de modo reduzido o trabalho de dissertação de Doutoramento em Psicologia da Educação, realizado pela autora em 1997, sob o titulo: Exploração e Desenvolvimento Vocacional de Jovens: Estudo sobre as relações entre a Exploração, a Identidade e a Indecisão Vocacional Fundação para a Ciência e a Tecnologia (FCT)

Deciding Where to Burn: Stakeholder Priorities for Prescribed Burning of a Fire-Dependent Ecosystem

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Jennifer K. Costanza

2011-03-01

Full Text Available Multiagency partnerships increasingly work cooperatively to plan and implement fire management. The stakeholders that comprise such partnerships differ in their perceptions of the benefits and risks of fire use or nonuse. These differences inform how different stakeholders prioritize sites for burning, constrain prescribed burning, and how they rationalize these priorities and constraints. Using a survey of individuals involved in the planning and implementation of prescribed fire in the Onslow Bight region of North Carolina, we examined how the constraints and priorities for burning in the longleaf pine (Pinus palustris ecosystem differed among three stakeholder groups: prescribed burn practitioners from agencies, practitioners from private companies, and nonpractitioners. Stakeholder groups did not differ in their perceptions of constraints to burning, and development near potentially burned sites was the most important constraint identified. The top criteria used by stakeholders to decide where to burn were the time since a site was last burned, and a site's ecosystem health, with preference given to recently burned sites in good health. Differences among stakeholder groups almost always pertained to perceptions of the nonecological impacts of burning. Prescribed burning priorities of the two groups of practitioners, and particularly practitioners from private companies, tended to be most influenced by nonecological impacts, especially through deprioritization of sites that have not been burned recently or are in the wildland-urban interface (WUI. Our results highlight the difficulty of burning these sites, despite widespread laws in the southeast U.S. that limit liability of prescribed burn practitioners. To avoid ecosystem degradation on sites that are challenging to burn, particularly those in the WUI, conservation partnerships can facilitate demonstration projects involving public and private burn practitioners on those sites. In summary

Using relative humidity to predict spotfire probability on prescribed burns

Science.gov (United States)

John R. Weir

2007-01-01

Spotfires have and always will be a problem that burn bosses and fire crews will have to contend with on prescribed burns. Weather factors (temperature, wind speed and relative humidity) are the main variables burn bosses can use to predict and monitor prescribed fire behavior. At the Oklahoma State University Research Range, prescribed burns are conducted during...

12 CFR 308.13 - Change of time limits.

Science.gov (United States)

2010-01-01

... PRACTICE AND PROCEDURE Uniform Rules of Practice and Procedure § 308.13 Change of time limits. Except as otherwise provided by law, the administrative law judge may, for good cause shown, extend the time limits prescribed by the Uniform Rules or by any notice or order issued in the proceedings. After the referral of...

A Implicação do Afeto na Psicologia do Desenvolvimento: uma Perspectiva Contemporânea

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José Carlos Chaves Brazão

2015-06-01

Full Text Available Este texto aborda o papel do afeto no desenvolvimento humano, sua implicação na emergência das funções cognitivas superiores, incluindo a linguagem, sua importância como mediador nas relações intersubjetivas e, principalmente, na socialização da criança. Tomamos como referência autores clássicos, como Henri Wallon, e contemporâneos, como Maturana, conjugados sob uma perspectiva desenvolvimentista. Apresentamos, sucintamente, os trabalhos de Daniel N. Stern, cuja teoria da emergência dos sensos de si, compreendidos como perspectivas autônomas para organização da experiência subjetiva, tornou-se referência entre teóricos e clínicos da Psicologia do Desenvolvimento, pela descrição de conceitos tais como a sintonia afetiva, os afetos de vitalidade, a percepção amodal, dentre outros, tão importantes para a compreensão dos processos relacionais humanos. Salientamos, também, as intervenções de base afetiva, visando estimular os processos básicos de interafetividade, compreendidos por serem deficitários em transtornos do desenvolvimento tais como o autismo, enfatizando a sua relevância. Concluímos que a interafetividade é um fator essencial para o desenvolvimento saudável da criança, um agente de socialização, e um poderoso recurso interventivo na clínica.

A ONU e o desenvolvimento econômico: uma interpretação das bases teóricas da atuação do PNUD The UN and economic development: an interpretation on the theoretical basis of the UNDP’s action

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João Guilherme Rocha Machado

2008-04-01

Full Text Available O Programa das Nações Unidas para o Desenvolvimento (PNUD se destaca como importante órgão da Organização das Nações Unidas para a questão do desenvolvimento. Ele também é responsável pela elaboração e publicação do Índice de Desenvolvimento Humano (IDH. O PNUD atua em mais de 166 países e exerce influência importante na teoria e nas práticas relacionadas ao desenvolvimento econômico. É muito relevante ter elementos que possam esclarecer os reais alcances e limites de atuação deste Programa. Assim o objetivo deste artigo é identificar, sistematizar e interpretar de forma crítica a base teórica do paradigma do desenvolvimento humano, no qual se fundamenta a atuação do PNUD. A abordagem das capacidades de Amartya Sen constitui a base teórica do paradigma do desenvolvimento humano. Essa abordagem é bastante conveniente à natureza pragmática e consensual da atuação do PNUD, pois propõe um foco maior na expansão das capacidades individuais, mas sem pleitear por mudanças estruturais na ordem econômica internacional.The United Nations Development Programme (UNDP is an important body of the United Nations for development issues. It is also responsible for the construction and publication of the Human Development Index (HDI. The UNDP is present in more than 166 countries and exerts an influence on the theory and practice of economic development. It is very important to define the elements which allow the establishment of limits to the UNDP’s action. The purpose of this paper is to identify, classify and critically explain the theoretical basis for the paradigm of human development, on which its line of work has been based. The capabilities approach developed by Amartya Sen is the theoretical basis for the paradigm of human development. This approach is very convenient for the pragmatic and consensual nature of the UNDP’s action because it proposes a greater focus on the expansion of individual capabilities, but

Issues with prescribed medications in Aboriginal communities: Aboriginal health workers' perspectives.

Science.gov (United States)

Hamrosi, Kim; Taylor, Susan J; Aslani, Parisa

2006-01-01

The health of Indigenous Australians remains appalling. The causes of this situation are multi-factorial, however one contributing factor is poor medication compliance within Aboriginal populations. Anecdotal evidence provided by Aboriginal health workers in western New South Wales (NSW), Australia, has suggested that there are problems associated with the use of prescribed medications within the Aboriginal community. Aboriginal health workers form a core component of the Aboriginal health service sector and they have an in-depth knowledge of the community and its healthcare provision, as well as a familiarity with clinic patients and families. As such they are an important group whose opinions and beliefs about medication use in the Aboriginal population should be investigated. While there have been studies on the issues of prescribing in Aboriginal communities and access to medications, limited investigation into the use of prescribed medicines in Aboriginal communities and the role of the pharmacist in that process, has taken place. Therefore, this research aimed to identify the type of and reasons for inappropriate use of prescribed medications within Aboriginal communities serviced by the Mid Western Area Health Service (since incorporated into the Greater West Area Health Service) as perceived by the Aboriginal health workers in the area, and to explore strategies in conjunction with those Aboriginal health workers to address identified issues. Qualitative, in-depth interviews were held with 11 Aboriginal health workers employed in Community Health Centres and hospitals in the Mid Western Area Health service of NSW. The interviews were audiotaped and transcribed verbatim. The transcripts were content analysed for emerging themes. The interviews explored the beliefs, perceptions and experiences of the Aboriginal health workers regarding prescribed medication use, the role of the pharmacist, and identification of future strategies to improve medication use in

E-Prescribing Errors in Community Pharmacies: Exploring Consequences and Contributing Factors

Science.gov (United States)

Stone, Jamie A.; Chui, Michelle A.

2014-01-01

Objective To explore types of e-prescribing errors in community pharmacies and their potential consequences, as well as the factors that contribute to e-prescribing errors. Methods Data collection involved performing 45 total hours of direct observations in five pharmacies. Follow-up interviews were conducted with 20 study participants. Transcripts from observations and interviews were subjected to content analysis using NVivo 10. Results Pharmacy staff detected 75 e-prescription errors during the 45 hour observation in pharmacies. The most common e-prescribing errors were wrong drug quantity, wrong dosing directions, wrong duration of therapy, and wrong dosage formulation. Participants estimated that 5 in 100 e-prescriptions have errors. Drug classes that were implicated in e-prescribing errors were antiinfectives, inhalers, ophthalmic, and topical agents. The potential consequences of e-prescribing errors included increased likelihood of the patient receiving incorrect drug therapy, poor disease management for patients, additional work for pharmacy personnel, increased cost for pharmacies and patients, and frustrations for patients and pharmacy staff. Factors that contribute to errors included: technology incompatibility between pharmacy and clinic systems, technology design issues such as use of auto-populate features and dropdown menus, and inadvertently entering incorrect information. Conclusion Study findings suggest that a wide range of e-prescribing errors are encountered in community pharmacies. Pharmacists and technicians perceive that causes of e-prescribing errors are multidisciplinary and multifactorial, that is to say e-prescribing errors can originate from technology used in prescriber offices and pharmacies. PMID:24657055

Beyond the basics: refills by electronic prescribing.

Science.gov (United States)

Goldman, Roberta E; Dubé, Catherine; Lapane, Kate L

2010-07-01

E-prescribing is part of a new generation of electronic solutions for the medical industry that may have great potential for improving work flow and communication between medical practices and pharmacies. In the US, it has been introduced with minimal monitoring of errors and general usability. This paper examines refill functionality in e-prescribing software. A mixed method study including focus groups and surveys was conducted. Qualitative data were collected in on-site focus groups or individual interviews with clinicians and medical office staff at 64 physician office practices. Focus group participants described their experiences with the refill functionality of e-prescribing software, provided suggestions for improving it, and suggested improvements in office procedures and software functionality. Overall, approximately 50% reduction in time spent each day on refills was reported. Overall reports of refill functionality were positive; but clinicians and staff identified numerous difficulties and glitches associated managing prescription refills. These glitches diminished over time. Benefits included time saved as well as patient convenience. Potential for refilling without thought because of the ease of use was noted. Clinicians and staff appreciated the ability to track whether patients are filling and refilling prescriptions. E-prescribing software for managing medication refills has not yet reached its full potential. To reduce work flow barriers and medication errors, software companies need to develop error reporting systems and response teams to deal effectively with problems experienced by users. Examining usability issues on both the medical office and pharmacy ends is required to identify the behavioral and cultural changes that accompany technological innovation and ease the transition to full use of e-prescribing software. 2010 Elsevier Ireland Ltd. All rights reserved.

Alinhando objetivos estratégicos e processo de desenvolvimento em empresas de software

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André Leme Fleury

2014-06-01

Full Text Available Sistemas de software são atualmente responsáveis por parte significativa das inovações tecnológicas viabilizadas em produtos e serviços. A história do software é recente, assim como são recentes as pesquisas sobre o tema, que tem como foco principal o aprimoramento dos seus processos de desenvolvimento. Apesar das contribuições trazidas por essas teorias, a questão do alinhamento entre objetivos estratégicos e o processo de desenvolvimento nas empresas de software considerando as suas principais capacidades produtivas permanece um tema inexplorado. Como consequência, técnicas da engenharia de software são aplicadas sem incorporar considerações de valor nos processos de análise e na tomada de decisões. Este artigo analisa e apresenta soluções para duas questões: como diferenciar as empresas de software de acordo com seus processos produtivos mais relevantes e como garantir que esses processos de desenvolvimento encontram-se alinhados com os objetivos do negócio. A abordagem resultante inclui um referencial para classificação de empresas de software e uma técnica de planejamento tecnológico para essas empresas. O projeto de pesquisa incluiu a realização de surveys, pesquisa-ação e estudos de caso.

The Quality of Prescribing for Psychiatric Patients

DEFF Research Database (Denmark)

Soerensen, A L; Nielsen, L P; Poulsen, B K

2014-01-01

The Quality of Prescribing for Psychiatric PatientsSoerensen AL1,2, Nielsen LP3,4, Poulsen BK3, Lisby M3,5, Mainz J6,7 1Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Denmark; 2University College of Northern Denmark; 3......, Aalborg; Denmark OBJECTIVES: Prescribing for adult psychiatric patients is often highly complex due to the nature of psychiatric conditions, but also due to somatic comorbidity. Therefore, the aim of this study was to identify prevalence and types of potential inappropriate prescribing (PIP), asses...... the severity of potential clinical consequences and identify possible predictive factors of PIP.METHODS: The study was designed as a prospective study of PIP using medication reviews. Patients who were admitted during a 4 month period (August 2013 - November 2013) to a psychiatric university hospital were...

The Quality of Prescribing for Psychiatric Patients

DEFF Research Database (Denmark)

Sørensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt

2014-01-01

The Quality of Prescribing for Psychiatric Patients Soerensen AL1,2, Nielsen LP3,4, Poulsen BK3, Lisby M3,5, Mainz J6,7 1Danish Center for Healthcare Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Denmark; 2University College of Northern Denmark; 3......, Aalborg; Denmark OBJECTIVES: Prescribing for adult psychiatric patients is often highly complex due to the nature of psychiatric conditions, but also due to somatic comorbidity. Therefore, the aim of this study was to identify prevalence and types of potential inappropriate prescribing (PIP), asses...... the severity of potential clinical consequences and identify possible predictive factors of PIP. METHODS: The study was designed as a prospective study of PIP using medication reviews. Patients who were admitted during a 4 month period (August 2013 - November 2013) to a psychiatric university hospital were...

Curva ambiental de Kuznets e desenvolvimento econômico sustentável

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Ronaldo A. Arraes

2006-09-01

Full Text Available A motivação deste artigo se baseia na controvérsia existente na literatura recente sobre crescimento econômico, desenvolvimento sustentável e proteção ambiental, gerada a partir da evidência empírica mostrada inicialmente por Grossman e Krueger (1995, 1996, onde a relação entre PIB per capita e emissão de poluentes toma a forma de um U-invertido, denominada na literatura como Curva Ambiental de Kuznets (CAK. Este artigo se distingue por contribuir com a explicação de fatores ligados ao desenvolvimento econômico. Como essa relação tem sido recentemente contestada, muitas interpretações estruturais da CAK têm permanecido fortemente sob o amparo ad hoc. A questão sobre tal fato estilizado é se o crescimento econômico gera por si só uma proteção automática ao meio ambiente, vis a vis ao desenvolvimento sustentável. A partir de dados em painel para países, verifica-se que as variáveis que denotam desenvolvimento sustentável apresentam uma relação fraca com o PIB per capita, quanto a sua representação para uma CAK. Há evidências para curvas ambientais com formato cúbico, indicando que o fenômeno pode ser cíclico, rejeitando-se assim as CAK originais, além de todos os indicadores de desenvolvimento selecionados apontarem para divergências entre países, exceção apenas para o indicador relacionado à educação.The motivation of this article bases on the controversy in the recent literature about economic growth, sustainable development and environmental protection, started with the empirical evidences presented by Grossman and Krueger (1995, 1996, where the relationship between per capita GDP and emission of pollutants takes the shape of an inverted-U, denominated in the literature as Environmental Kuznets Curves (EKC. This article differs from others by contributing with further explanation stemming from economic development indicators. Despite being contested by many authors, several structural

Circulação de crianças: o olhar do cuidador sobre o desenvolvimento emocional

OpenAIRE

OLIVEIRA, Lesly Guimarães Vicenzi de

2012-01-01

O presente estudo teve como objetivo compreender a forma como cuidadores, pais e/ou responsáveis, compreendem o desenvolvimento emocional no contexto de circulação de crianças. Para tanto, embasou-se na teoria psicodinâmica sobre o desenvolvimento emocional, cuidador (es) e circulação de crianças.Utilizou-se o método qualitativo, no intuito de capturar dados e informações sobre o fenômeno estudado em sua singularidade (MINAYO, 2010). A dimensão interdisciplinar do presente estudo,...

Desenvolvimento econômico e social no território brasileiro: a expansão metropolitana e a Macrometrópole Paulista

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Paulo Romano Reschilian

2016-01-01

Full Text Available O trabalho se propõe a investigar as relações do processo histórico de desenvolvimento no território brasileiro associados às teorias e modelos de desenvolvimento e o surgimento da Macrometrópole Paulista. A expansão metropolitana no território brasileiro representa a “hegemonia global” capitalista que congrega uma rede de grandes empresas, associadas aos modelos de desenvolvimento econômico, criando assim, espaços de riqueza e pobreza dentro do mesmo território como pode-se verificar a partir das análises do Atlas do Desenvolvimento Humano nas Regiões Metropolitanas (2014. A partir dos anos de 1970 e do II Plano Nacional de Desenvolvimento surgem as políticas de desconcentração industrial e o Plano da Macrometrópole Paulista. Pode-se observar no contexto histórico, que no Estado de São Paulo, São Paulo foi a capital que melhor se afirmou na hegemonia econômica do capitalismo, tratando-se de um arranjo territorial produtivo que tende a reforçar a “modernização para poucos ”.

Estimating fuel consumption during prescribed fires in Arkansas

Science.gov (United States)

Virginia L. McDaniel; James M. Guldin; Roger W. Perry

2012-01-01

While prescribed fire is essential to maintaining numerous plant communities, fine particles produced in smoke can impair human health and reduce visibility in scenic areas. The Arkansas Smoke Management Program was established to mitigate the impacts of smoke from prescribed fires. This program uses fuel loading and consumption estimates from standard fire-behavior...

O IMPULSO DA ECONOMIA CRIATIVA NO DESENVOLVIMENTO REGIONAL NO MÉXICO / THE IMPROVEMENT OF THE CREATIVE ECONOMY IN REGIONAL DEVELOPMENT IN MEXICO

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Áurea Machado de Aragão

2017-03-01

Full Text Available Este artigo busca analisar a economia criativa como propulsora do desenvolvimento da economia mexicana. Busca também, diferenciar o crescimento econômico moderno com base na constante inovação, desenvolvimento e atraso econômico, a partir da revisão dos aportes e limitações da economia. Utilizou-se o método bibliográfico de análise histórico-comparativo para atender à proposta de unificar os aspectos da teoria do desenvolvimento e da teoria institucionalista com alguns elementos do estatuto dos processos complexos, em particular, a dependência do caminho, aplicados a um caso no México, a fim de delinear o seu desenvolvimento histórico e a explicação para o desempenho econômico do país. 

What supports hospital pharmacist prescribing in Scotland? - A mixed methods, exploratory sequential study.

Science.gov (United States)

Fisher, J; Kinnear, M; Reid, F; Souter, C; Stewart, D

2018-05-01

While approximately half of all qualified hospital pharmacist independent prescribers (PIPs) in Scotland are active prescribers, there are major differences in prescribing activity across geographical areas. This study aimed to explore, through focus groups, interviews and a questionnaire, hospital PIPs' perceptions of factors associated with prescribing activity and to investigate the infrastructure required to better support active prescribing by PIPs. Findings reinforced the perceived positive impact of supportive pharmacy leadership within the organisation, recognition that prescribing is integral to the clinical pharmacist role and a work environment conducive to prescribing. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Blueprint for prescriber continuing education program.

Science.gov (United States)

2012-06-01

On October 25, 2011, the Center for Drug Evaluation and Research (CDER) of the Food and Drug Administration (FDA) posted online this Blueprint for Prescriber Continuing Education, labeled "final," relating to extended-release and long-acting opioids. The pending FDA Risk Evaluation Management Strategy (REMS) requires prescriber education. This document provides guidance to sponsors of these dosage forms in developing the prescvriber education component of their REMS. This report was posted online by the federal agency on October 25, 2011 at: http://www.fda.gov/downloads/drugs/drugsafety/informationbydrugclass/ucm277916.pdf. It is in the public domain.

Sensibilizar professores para o desenvolvimento de carreira dos alunos: relato de uma experiência

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Íris M. Oliveira

Full Text Available A literatura destaca a importância de realizar sessões de sensibilização dos professores para promover a sua influência positiva e intencional, enquanto docentes, nas trajetórias de carreira dos alunos. Este artigo relata uma experiência de realização de uma sessão de sensibilização junto a professores da educação básica de um agrupamento de escolas no noroeste de Portugal. Procurou-se esclarecer o conceito de desenvolvimento de carreira junto dos professores, conscientizá-los para o papel da escola no desenvolvimento de carreira dos alunos e estimular a dinamização de atividades promotoras desse processo. Apresenta-se a estrutura da sessão, as estratégias adotadas para alcançar os objetivos propostos e as reflexões partilhadas e debatidas pelos professores. As apreciações dos intervenientes quanto à sessão de sensibilização mostraram-se favoráveis. Esta experiência ilustra a importância de realizar sessões de sensibilização dos professores nesse domínio, as quais podem sustentar a promoção do desenvolvimento de carreira dos alunos, ao longo da escolaridade.

Análise e avaliação das políticas públicas: seu impacto no desenvolvimento local em Angola

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Carlos dos Santos Teixeira

2015-01-01

Full Text Available Em Angola, o Plano Nacional de Desenvolvimento 2013–2017 constitui um dos principais repositórios de políticas públicas para Angola. As principais linhas de força do Orçamento Geral do Estado angolano para 2014, aponta o Sector Social como aquele que mais diretamente pode reflectir ma melhoria das condições de vida da população, absorvendo uma fatia de 1/3 do orçamento. As políticas públicas das áreas da Saúde, Educação e Assistência Social, adoptadas pelo Executivo Angolano, podem ser consideradas como um exemplo para a promoção do desenvolvimento local. No entanto, desafios persistem no quadro da desconcentração financeira do Estado e da autonomia plena dos municípios, como forma de induzir o desenvolvimento econômico local e a maior participação dos actores locais na agenda do desenvolvimento nacional.

Metodologia de avaliação e desenvolvimento de grupos de alto desempenho

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Ana Cristina Carneiro

2008-11-01

Full Text Available Este artigo discute a fundamentação teórica do Projeto de Avaliação e Desenvolvimento de Grupos de Alto Desempenho, concebido com base na metodologia da Meta-aprendizagem, e no Modelo Evolutivo, estendido à luz da Teoria da Complexidade. Visa ao desenvolvimento e aplicação de uma metodologia de avaliação/constituição de grupos de alto desempenho no ambiente de pesquisa e pós-graduação. A metodologia proposta validada empiricamente teve base no aproveitamento das virtudes e potencialidades das teorias que lhe deram origem. É destinado aos docentes e pesquisadores de vários campos do conhecimento, bem como aos dirigentes de instituições de educação superior e de pesquisa.

An audit of prescribing practices for benzodiazepines and Z-drugs.

LENUS (Irish Health Repository)

Cadogan, C

2015-03-01

Concerns persist over the use of benzodiazepines and Z-drugs in Ireland. A prospective prescription audit was conducted in 81 community pharmacies across Ireland over a four week period. The study sought to assess the level of prescription compliance with key components of benzodiazepine and Z-drug prescribing guidelines. 28% of audit booklets issued were returned, yielding data on 4,418 prescriptions. The findings suggest that little progress has been made in improving the prescribing of benzodiazepines and Z-drugs in Ireland in the decade since publication of the Benzodiazepine Committee\\'s report. Fewer than one fifth of prescriptions (18.8%) were fully compliant with the assessment criteria and the majority (53.7%) had multiple discrepancies. This study highlights the importance of monitoring and auditing benzodiazepine and Z-drug prescribing practices. Interventions involving patients, prescribers and pharmacists are required to improve the prescribing and use of these medications in Ireland.

Rationalising prescribing: Evidence, marketing and practice-relevant knowledge.

Science.gov (United States)

Wadmann, Sarah; Bang, Lia E

2015-06-01

Initiatives in the name of 'rational pharmacotherapy' have been launched to alter what is seen as 'inappropriate' prescribing practices of physicians. Based on observations and interviews with 20 general practitioners (GPs) in 2009-2011, we explored how attempts to rationalise prescribing interact with chronic care management in Denmark. We demonstrate how attempts to rationalise prescribing by informing GPs about drug effects, adverse effects and price do not satisfy GPs' knowledge needs. We argue that, for GPs, 'rational' prescribing cannot be understood in separation from the processes that enable patients to use medication. Therefore, GPs do much more to obtain knowledge about medications than seek advice on 'rational pharmacotherapy'. For instance, GPs also seek opportunities to acquaint themselves with the material objects of medication and medical devices. We conceptualise the knowledge needs of GPs as a need for practice-relevant knowledge and argue that industry sales representatives are granted opportunity to access general practice because they understand this need of GPs. Copyright © 2015 Elsevier Ltd. All rights reserved.

O FENÔMENO TURISMO: REFLEXÕES SOBRE A COMPLEXIDADE DA CADEIA PRODUTIVA DO TURISMO E DO DESENVOLVIMENTO REGIONAL ENDÓGENO

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Mary Sandra Guerra Ashton

2008-01-01

Full Text Available O artigo apresenta como objetivo principal uma reflexão em torno da problemática relacionada ao desenvolvimento regional endógeno e à cadeia produtiva do turismo. Apóia-se na necessidade de compreender como estas relações podem contribuir para o desempenho de sistemas sociais e econômicos. Para tanto, busca sustentação teórica nas noções de desenvolvimento regional endógeno, desenvolvida por Sen, Veiga e Barquero, e da cadeia produtiva do turismo, a partir de autores como Beni e Leiper, bem como na compreensão do fenômeno turismo conforme De La Torre e Fúster. Pressupõe-se que a atividade turística organizada por meio do enfoque sistêmico e sua implantação em nível municipal ou regional, a partir das potencialidades locais e do conjunto dessas relações, podem resultar em contribuições para o desenvolvimento das regiões. Palavras-chave: Turismo. Fenômeno Social. Cadeia Produtiva do Turismo. Desenvolvimento Regional. Endogenia.

Prescribed burning: a topical issue

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Bovio G

2013-11-01

Full Text Available Prescribed burning is a promising technique for the prevention of forest fires in Italy. The research deepened several ecological and operative aspects. However, legal issues need to be thoroughly investigated.

[Prescribing antibiotics for sore throat: a persistent habit].

Science.gov (United States)

Damoiseaux, Roger A M J; Venekamp, Roderick P

2015-01-01

Recently the revision of the guideline of the Dutch College of General Practitioners on sore throat has been published. Again, one of the key messages is restricting the use of antibiotics. In the Netherlands general practitioners prescribe antibiotics in 50% of cases of tonsillitis. Although there has been a decrease in the number of antibiotic prescriptions for tonsillitis in the last 30 years, they are still being prescribed twice as often as is recommended by the guideline. The beliefs of both patient and doctor play an important role in prescribing and better communication might help to improve the situation. Public campaigns can also help by providing the best knowledge on the effectiveness of antibiotics to the public.

Prescribing psychotropic drugs to adults with an intellectual disability

Science.gov (United States)

Trollor, Julian N; Salomon, Carmela; Franklin, Catherine

2016-01-01

SUMMARY Mental illness is common in people with intellectual disability. They may also have physical health problems which can affect their mental state. Difficulties in communication can contribute to mental health problems being overlooked. These may present with changes in behaviour. Psychological management is usually preferable to prescribing psychotropic drugs. Behavioural approaches are the most appropriate way to manage challenging behaviour. If a drug is considered, prescribers should complete a thorough diagnostic assessment, exclude physical and environmental contributions to symptoms, and consider medical comorbidities before prescribing. Where possible avoid psychotropics with the highest cardiometabolic burden. Prescribe the minimum effective dose and treatment length, and regularly monitor drug efficacy and adverse effects. There is insufficient evidence to support the use of psychotropics for challenging behaviour. They should be avoided unless the behaviour is severe and non-responsive to other treatments. PMID:27756975

De Piaget a Gilligan: retrospectiva do desenvolvimento moral em psicologia um caminho para o estudo das virtudes

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Vanessa Aparecida Alves de Lima

Full Text Available Este artigo é a adaptação de um capítulo da dissertação desenvolvida no Mestrado em Psicologia Escolar e do Desenvolvimento Humano do Instituto de Psicologia da USP. Implica a visitação teórica das obras de Jean Piaget, Lawrence Kohlberg e Carol Gilligan sobre o desenvolvimento moral na perspectiva da Psicologia. As teorias são construídas a partir de uma concepção da moralidade por meio de fatores cognitivos e baseados na justiça, na opinião dos dois primeiros autores, até o desenvolvimento da ética do cuidado, na teoria da terceira autora. Tal caminho nos leva inevitavelmente a considerar que diversos elementos, não só a justiça, participam do juízo e da ação moral, entre eles, virtudes como a generosidade.

A nova divisão internacional do trabalho, capitalismo cognitivo e desenvolvimento na América Latina

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Carlo Vercellone

2016-12-01

Full Text Available O artigo propõe revisar questões relacionadas ao desenvolvimento da América Latina em função das transformações inerentes à crise do capitalismo industrial e à transição a um ‘novo capitalismo’, categorizado como capitalismo cognitivo. Com este objetivo, a análise está dividida em três partes. Na primeira parte se propõe uma revisão da crise estrutural do paradigma da industrialização, legado das teorias do desenvolvimento formuladas entre os anos 1950-1980. A segunda parte aborda as dificuldades e desafios produzidos pela nova divisão internacional do trabalho, fundada sobre os princípios cognitivos e o fortalecimento dos direitos de propriedade intelectual. E, finalmente uma terceira parte na qual se busca identificar certas características de uma estratégia de desenvolvimento pós-industrial para os países latino-americanos.

Impacts of prescribed fire on Pinus rigida Mill

Science.gov (United States)

Nicholas J. Carlo; Heidi J. Renninger; Kenneth L. Clark; Karina V.R. Schäfer

2016-01-01

A comparative analysis of the impacts of prescribed fire on three upland forest stands in the Northeastern Atlantic Plain, NJ, USA, was conducted. Effects of prescribed fire on water use and gas exchange of overstory pines were estimated via sap-flux rates and photosynthetic measurements on Pinus rigida Mill. Each study site had two sap-flux plots...

Prokinetics prescribing in paediatrics: evidence on cisapride, domperidone, and metoclopramide.

Science.gov (United States)

Mt-Isa, Shahrul; Tomlin, Stephen; Sutcliffe, Alastair; Underwood, Martin; Williamson, Paula; Croft, Nicholas M; Ashby, Deborah

2015-04-01

Domperidone and metoclopramide are prokinetics commonly prescribed off-label to infants and younger children in an attempt to treat gastro-oesophageal reflux symptoms. Another prokinetic drug, cisapride, was used but withdrawn in 2000 in the United Kingdom because of serious arrhythmic adverse events. Medicines and Healthcare Products Regulatory Agency issued safety warnings for domperidone in May 2012 and restricted its indications. We report here national primary care prescribing trends and safety signals of these drugs in children. We used data from the General Practice Research Database between 1990 and 2006 for children <18 years. Descriptive statistics and Poisson regressions were performed to characterise prescribing trends. We examined safety signals in nested case-control studies. The proportion of children <2 years old being prescribed one of the medications doubled during the study period. Prescriptions of domperidone increased 10-fold, mainly following the withdrawal of cisapride in 2000. Prescriptions of metoclopramide did not change significantly. Despite the increase in prescriptions of domperidone, no new safety signals were identified. These data showed dramatic changes in prescribing of cisapride and domperidone despite the lack of good-quality supporting evidence. It is possible that these prescribing trends were influenced by published guidelines. Even if produced without robust efficacy and safety evidence, published guidelines can influence clinicians and consequently affect prescribing. Therefore, improving the evidence base on prokinetics to inform future guidelines is vital. The lack of new safety signals during this period would support the development of suitable powered clinical studies.

Questões éticas da pesquisa em Psicologia do Desenvolvimento

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Patrícia Alvarenga

Full Text Available A pesquisa em Psicologia do desenvolvimento impõe aos pesquisadores desafios e dilemas éticos peculiares, especialmente em se tratando de investigações que envolvem crianças e adolescentes. O presente estudo tem o objetivo de apresentar e discutir algumas dessas questões éticas, como a obtenção do Consentimento Livre e Esclarecido, o encaminhamento dos participantes para tratamento e a devolução de avaliações, o uso de instrumentos que não foram validados, os dilemas relativos à sexualidade e saúde de adolescentes e as questões éticas referentes à realização de estudos de caso. Os questionamentos e as reflexões propostos basearam-se, essencialmente, na prática de pesquisa dos próprios autores, em grande parte respaldada pela legislação brasileira e pela literatura sobre ética da pesquisa com seres humanos e da pesquisa em Psicologia. Contudo, constatou-se a existência de várias lacunas na literatura sobre o tema, que indicam a necessidade de aprofundamento do debate sobre a ética na pesquisa em Psicologia do desenvolvimento.

Prescribing of Electronic Activity Monitors in Cardiometabolic Diseases: Qualitative Interview-Based Study.

Science.gov (United States)

Bellicha, Alice; Macé, Sandrine; Oppert, Jean-Michel

2017-09-23

The prevalence of noncommunicable diseases, including those such as type 2 diabetes, obesity, dyslipidemia, and hypertension, so-called cardiometabolic diseases, is high and is increasing worldwide. Strong evidence supports the role of physical activity in management of these diseases. There is general consensus that mHealth technology, including electronic activity monitors, can potentially increase physical activity in patients, but their use in clinical settings remains limited. Practitioners' requirements when prescribing electronic activity monitors have been poorly described. The aims of this qualitative study were (1) to explore how specialist physicians prescribe electronic activity monitors to patients presenting with cardiometabolic conditions, and (2) to better understand their motivation for and barriers to prescribing such monitors. We conducted qualitative semistructured interviews in March to May 2016 with 11 senior physicians from a public university hospital in France with expertise in management of cardiometabolic diseases (type 1 and type 2 diabetes, obesity, hypertension, and dyslipidemia). Interviews lasted 45 to 60 minutes and were audiotaped, transcribed verbatim, and analyzed using directed content analysis. We report our findings following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Most physicians we interviewed had never prescribed electronic activity monitors, whereas they frequently prescribed blood glucose or blood pressure self-monitoring devices. Reasons for nonprescription included lack of interest in the data collected, lack of evidence for data accuracy, concern about work overload possibly resulting from automatic data transfer, and risk of patients becoming addicted to data. Physicians expected future marketing of easy-to-use monitors that will accurately measure physical activity duration and intensity and provide understandable motivating feedback. Features of electronic activity monitors

Health Alliance for prudent antibiotic prescribing in patients with Respiratory Tract Infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme

DEFF Research Database (Denmark)

Bjerrum, Lars; Munck, Anders; Gahrn-Hansen, Bente

2011-01-01

ABSTRACT: BACKGROUND: Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence...... with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention....

Primary care hypnotic and anxiolytic prescription: Reviewing prescribing practice over 8 years

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Lloyd D Hughes

2016-01-01

Full Text Available Introduction: Over the last few years, hypnotic and anxiolytic medications have had their clinical efficacy questioned in the context of concerns regarding dependence, tolerance alongside other adverse effects. It remains unclear how these concerns have impacted clinical prescribing practice. Materials and Methods: This is a study reviewing community-dispensed prescribing data for patients on the East Practice Medical Center list in Arbroath, Scotland, in 2007, 2011 and 2015. Anxiolytic and hypnotic medications were defined in accordance with the British National Formulary chapter 4.1.1 and chapter 4.1.2. All patients receiving a drug within this class in any of the study years were collated and anonymized using primary care prescribing data. The patients′ age, gender, name of the prescribed drug(s, and total number of prescriptions in this class over the year were extracted. Results: The proportion of patients prescribed a benzodiazepine medication decreased between 2007 and 2015: 83.8% (n = 109 in 2007, 70.5% (n = 122 in 2011, and 51.7% (n = 138 in 2015 (P = 0.006. The proportion of these patients prescribed a nonbenzodiazepine drug increased between 2007 and 2015: 30% (n = 39 in 2007, 46.2% (n = 80 in 2011, and 52.4% (n = 140 in 2015 (P = 0.001. There was a significant increase in the number of patients prescribed melatonin (P = 0.020. Discussion: This study reports a reduction in benzodiazepine prescriptions in primary care alongside increases in nonbenzodiazepine and melatonin prescribing, with an increase in prescribing rates of this drug class overall. Conclusion: Changes in this prescribing practice may reflect the medicalization of insomnia, local changes in prescribing practice and alongside national recommendations.

ETHICAL PRACTICES IN DRUG PRESCRIBING. A COMPARATIVE STUDY BETWEEN DOCTORS’ AND PHARMACISTS’ OPINION ABOUT DRUG PRESCRIBING IN ROMANIA

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LASZLO-ZOLTAN SZTANKOVSZKY

2015-11-01

Full Text Available The prescription of drugs is influenced by a number of factors with a great impact upon the health of the main beneficiaries of health services. The purpose of the study is to identify the perception of doctors and pharmacists on drug prescription practices adopted by doctors. Material and Methods: a number of 349 subjects (149 pharmacists and 200 doctors answered a survey about the perception of drug dispensing in Romania. Variables like age, work environment (urban, rural, length of employment were taken into account. Results: When prescribing a treatment, 93% of doctors follow the standard treatment protocol for the given diagnosis and 93,5% of them are declaring that personal resources are the main source for training while the percent appreciated by pharmacists is evaluated to 65,78%. A total of 50% of doctors are considering other criteria than the treatment when prescribing a drug (financial contribution for the patient or National Health Insurance House. A total of 59% of doctors are recommending overthe-counter products while pharmacists consider that is happening in more than 70% of the cases. Conclusions: There are differences of opinion between doctors and pharmacists regarding doctor’s practices of prescribing drugs to their patients, like: kinds of sponsorship for the continuing education, the relationship with the pharmaceutical representative or the frequency of prescribing over-the-counter products or supplements when they are recommending a certain treatment.

Teaching young GPs to cope with psychosocial consultations without prescribing: a durable impact of an e-module on determinants of benzodiazepines prescribing.

Science.gov (United States)

Creupelandt, Hanne; Anthierens, Sibyl; Habraken, Hilde; Declercq, Tom; Sirdifield, Coral; Siriwardena, Aloysius Niroshan; Christiaens, Thierry

2017-12-19

Despite guidelines and campaigns to change prescribing behavior, General Practitioners (GPs) continue to overprescribe benzodiazepines (BZDs). New approaches to improve prescribing are needed. Using behavior change techniques and tailoring interventions to user characteristics are vital to promote behavior change. This study evaluated the impact of an e-module on factors known to determine BZD prescribing practice. A tailored e-module that focuses on avoiding initial BZD prescriptions (and using psychological interventions as an alternative) was developed and offered to GPs in vocational training. Three self-report assessments took place: at baseline, immediately after the module (short term) and at least six months after completion (long term). Assessed determinants include GPs' attitudes concerning treatment options, perceptions of the patient and self-efficacy beliefs. Readiness to adhere to prescribing guidelines was evaluated through assessing motivation, self-efficacy and implementability of non-pharmacological interventions. Changes in determinants were analyzed using the Wilcoxon signed-rank test. Changes in readiness to adhere to guidelines was analyzed using the nonparametric McNemar Bowker test. A desirable, significant and durable impact on determinants of BZD prescribing was observed. GPs (n = 121) underwent desirable changes in their attitudes, perceptions and self-efficacy beliefs and these changes remained significant months after the intervention. Barriers to using a non-pharmacological approach often cited in literature remained absent and were not highlighted by the intervention. Furthermore a significant impact on GPs' readiness to adhere to guidelines was observed. Participants reported change in their ability to cope with psychosocial consultations and to have tried using non-pharmacological interventions. Tailoring an e-intervention to target group (GPs) characteristics appears to be successful in promoting behavioral change in GPs

Matrix with Prescribed Eigenvectors

Science.gov (United States)

Ahmad, Faiz

2011-01-01

It is a routine matter for undergraduates to find eigenvalues and eigenvectors of a given matrix. But the converse problem of finding a matrix with prescribed eigenvalues and eigenvectors is rarely discussed in elementary texts on linear algebra. This problem is related to the "spectral" decomposition of a matrix and has important technical…

The impact of the government health funding on prescribing behaviors in community health institutions in China.

Science.gov (United States)

Sun, Gang; Lu, Zuxun; Gan, Yong; Dong, Xiaoxin; Li, Yongbin; Wang, Yunxia; Li, Liqing

2017-11-01

Government health funding (GHF) is a cosmopolitan problem. It is especially conspicuous in China, where drug sales become a main source of medical institutions' incomes due to limited GHF. This is well known as China's "drug maintain medical institutions (DMMIs)" system which results directly in very high use of antibiotics, injections, and corticosteroids. However, few statistical data existed in China on the association between the GHF and the prevalence of inappropriate drug prescribing, despite widespread acknowledgment of its existence.A multistage sampling strategy was employed to select 442,100 prescriptions written between 2007 and 2011 by urban community health (CH) institutions and check the GHF in 36 key cities (districts) across China. This study examined the association between the GHF and the prevalence of inappropriate drug prescribing, which differs somewhat from previous studies.The data suggested that from 2007 to 2011, with the increase of GHF, prescribing behaviors (PB) gradually improved on the whole although doctors still prescribed a few more drugs than the recommendations from World Health Organization (WHO). This study found that there is significant negative association between GHF and main indicators of PB (correlation coefficients more than 0.5).The findings implied that government should further perfect the compensation mechanism to medical institutions for gradually weakening the compensation function of drug sales in medical institutions.

Pediatricians' ideas about child development and education Concepções dos pediatras acerca da educação e do desenvolvimento infantil

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Cristina Nunes

2011-01-01

Full Text Available In Andalusia (Spain, pediatricians are the main formal counseling source about children's development and education. Unfortunately, there is a limited knowledge about their ideas, practices and skills to guide parents. In this study, through the content analysis of 26 pediatrician interviews, we describe their ideas and goals about anticipatory guidance. We also analyze their perceptions about parental practices and the educative messages given to parents. The results show that pediatrician agenda focus mainly on bio-medical issues, such as nutrition, accident prevention and growth monitoring. Child development and education are not priorities and issues like psychomotor development and language are only approached to fill out medical records.Na Andaluzia (Espanha, os pediatras são a principal fonte técnica de aconselhamento sobre o desenvolvimento e a educação infantil. No entanto existe um conhecimento limitado sobre as suas ideias, práticas e habilidades para orientar os pais. Neste estudo, através da análise de conteúdo das entrevistas realizadas a vinte e seis pediatras, descrevem-se os objectivos da agenda pediátrica, as percepções sobre as práticas parentais e as mensagens educativas transmitidas aos pais. Os resultados mostram que a agenda pediátrica é centrada sobretudo nos temas biomédicos, como alimentação, prevenção de acidentes e crescimento. O desenvolvimento e a educação da criança não são prioridades e os temas relacionados com o desenvolvimento psicomotor e linguagem são abordados sobretudo para preencher a história clínica.

Controlled Substance Prescribing Patterns--Prescription Behavior Surveillance System, Eight States, 2013.

Science.gov (United States)

Paulozzi, Leonard J; Strickler, Gail K; Kreiner, Peter W; Koris, Caitlin M

2015-10-16

Drug overdose is the leading cause of injury death in the United States. The death rate from drug overdose in the United States more than doubled during 1999-2013, from 6.0 per 100,000 population in 1999 to 13.8 in 2013. The increase in drug overdoses is attributable primarily to the misuse and abuse of prescription drugs, especially opioid analgesics, sedatives/tranquilizers, and stimulants. Such drugs are prescribed widely in the United States, with substantial variation by state. Certain patients obtain drugs for nonmedical use or resale by obtaining overlapping prescriptions from multiple prescribers. The risk for overdose is directly associated with the use of multiple prescribers and daily dosages of >100 morphine milligram equivalents (MMEs) per day. 2013. The Prescription Behavior Surveillance System (PBSS) is a public health surveillance system that allows public health authorities to characterize and quantify the use and misuse of prescribed controlled substances. PBSS began collecting data in 2012 and is funded by CDC and the Food and Drug Administration. PBSS uses standard metrics to measure prescribing rates per 1,000 state residents by demographic variables, drug type, daily dose, and source of payment. Data from the system can be used to calculate rates of misuse by certain behavioral measures such as use of multiple prescribers and pharmacies within specified time periods. This report is based on 2013 de-identified data (most recent available) that represent approximately one fourth of the U.S. Data were submitted quarterly by prescription drug monitoring programs (PDMPs) in eight states (California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio, and West Virginia) that routinely collect data on every prescription for a controlled substance to help law enforcement and health care providers identify misuse or abuse of such drugs. In all eight states, opioid analgesics were prescribed approximately twice as often as stimulants or benzodiazepines

Dichotomy in the definition of prescriptive information suggests both prescribed data and prescribed algorithms: biosemiotics applications in genomic systems.

Science.gov (United States)

D'Onofrio, David J; Abel, David L; Johnson, Donald E

2012-03-14

The fields of molecular biology and computer science have cooperated over recent years to create a synergy between the cybernetic and biosemiotic relationship found in cellular genomics to that of information and language found in computational systems. Biological information frequently manifests its "meaning" through instruction or actual production of formal bio-function. Such information is called prescriptive information (PI). PI programs organize and execute a prescribed set of choices. Closer examination of this term in cellular systems has led to a dichotomy in its definition suggesting both prescribed data and prescribed algorithms are constituents of PI. This paper looks at this dichotomy as expressed in both the genetic code and in the central dogma of protein synthesis. An example of a genetic algorithm is modeled after the ribosome, and an examination of the protein synthesis process is used to differentiate PI data from PI algorithms.

Dichotomy in the definition of prescriptive information suggests both prescribed data and prescribed algorithms: biosemiotics applications in genomic systems

Directory of Open Access Journals (Sweden)

D'Onofrio David J

2012-03-01

Full Text Available Abstract The fields of molecular biology and computer science have cooperated over recent years to create a synergy between the cybernetic and biosemiotic relationship found in cellular genomics to that of information and language found in computational systems. Biological information frequently manifests its "meaning" through instruction or actual production of formal bio-function. Such information is called Prescriptive Information (PI. PI programs organize and execute a prescribed set of choices. Closer examination of this term in cellular systems has led to a dichotomy in its definition suggesting both prescribed data and prescribed algorithms are constituents of PI. This paper looks at this dichotomy as expressed in both the genetic code and in the central dogma of protein synthesis. An example of a genetic algorithm is modeled after the ribosome, and an examination of the protein synthesis process is used to differentiate PI data from PI algorithms.

Ação coletiva e coprodução para o desenvolvimento rural: um estudo de caso do Colegiado de Desenvolvimento Territorial da Serra Catarinense

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Alexandre Coimbra Ribeiro

2015-02-01

Full Text Available Este artigo analisa a ação coletiva promovida pelo Colegiado de Desenvolvimento Territorial (Codeter da Serra Catarinense, buscando verificar se essa ação colaborou para mobilizar um processo de coprodução do bem público no planejamento e gestão do desenvolvimento rural no território. Foi empregada uma estratégia de investigação de estudo de caso que combinou a utilização de diversas técnicas qualitativas de coleta de dados, análise e interpretação dos resultados. Diferentes paradigmas que tratam da ação coletiva foram considerados, no intuito de examinar a ação concertada promovida no Codeter e suas características principais. Com base no conceito de coprodução e suas variáveis, verificamos que essa ação coletiva engendrou um novo tipo de ação pública, ampliando a participação e a colaboração entre os atores sociais na coconstrução de soluções para os problemas públicos do território.

Incubadoras de empresas e o desenvolvimento de capacidades em empresas incubadas

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José Eduardo Storopoli

2013-04-01

Full Text Available DOI: http://dx.doi.org/10.5007/2175-8077.2013v15n35p36   No Brasil, as incubadoras de empresa vêm-se consolidando ao longo dos anos com contribuições importantes para o processo de desenvolvimento de ideias que se transformam em negócios e também de empreendedores que se tornam empresários. As incubadoras permitem que as capacidades e recursos disponíveis deem suporte ao desenvolvimento das potencialidades empreendedoras de seus associados. Este trabalho analisa a contribuição desse processo para o desenvolvimento das empresas nos diferentes estágios de incubação. O método de pesquisa foi o estudo de casos múltiplos, com o gerente do CIETEC e quatro empresas em estágios distintos de incubação. A análise dos dados seguiu as técnicas de agrupamento e de cluster. Os principais resultados indicam que: a as capacidades possuem suas raízes em experiências profissionais ou acadêmicas dos empreendedores; b o papel da incubadora na formação dessas capacidades é passivo; c a capacitação de empreendedores para a elaboração de um plano de negócios é um fator positivo para o estabelecimento do negócio; d o networking proporcionado pela incubadora mostrou-se fundamental para todas as empresas; e a infraestrutura é importante para os estágios inicias de incubação, porém perde importância na medida em que as empresas avançam em seus estágios de incubação.

Investigation of Prescribed Fires Impacts on Air Quality in the Pacific Northwest

Science.gov (United States)

Ravi, V.; Chung, S. H.; Vaughan, J. K.; Lamb, B. K.

2014-12-01

Emissions from wildland and prescribed fires cause significant aerosol loading in the atmospheric environment. Using 2011 NEI-Fire emission inventory, we investigate the impacts of prescribed fire emissions on the air quality of the Pacific Northwest (PNW) for a month long period in October-November 2011. This study utilizes the AIRAPCT-4 regional air quality forecasting system, which is based on the WRF-SMOKE-CMAQ framework. We simulate three different emission scenarios - 1) emissions with prescribed fires, 2) emissions without prescribed fires and 3) a scenario where prescribed fire emissions are reduced by 60%. AIRPACT-4 results are examined for impacts of prescribed fire emissions on ambient levels of PM2.5 and Ozone for entire PNW. We also look at the contribution of prescribed fire emissions to ambient PM2.5 concentrations for selected non-attainment areas in the PNW. This work supports the analysis of using woody residue as a feedstock for an aviation biofuel supply chain through the Northwest Advanced Renewables Alliance (NARA).

Prevalence of inappropriate prescribing in primary care

DEFF Research Database (Denmark)

Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, Mogens Brandt

2007-01-01

to the patients. Topical, dermatological medications and medications not used regularly were excluded. RESULTS: 212 patients were prescribed 1621 medications by their GPs at baseline. In all, 640 (39.5%) of the medications had one or more inappropriate ratings in the 10 criteria making up the MAI. The main part...... is good. However, the majority of patients used one or more medications with inappropriate ratings. The inappropriate prescribing relates to specific therapeutic groups and criteria, which should be targeted in future interventions....

Avaliação e intervenção no desenvolvimento motor de uma criança com Síndrome de Down

OpenAIRE

Santos,Ana Paula Maurilia dos; Weiss,Silvio Luiz Indrusiak; Almeida,Geciely Munaretto Fogaça de

2010-01-01

o objetivo deste estudo foi analisar o desenvolvimento motor de uma criança com síndrome de Down e verificar os efeitos de um programa de intervenção motora específica. Trata-se de uma pesquisa descritiva do tipo estudo de caso. Para a avaliação do desenvolvimento motor foram utilizados os testes da Escala de Desenvolvimento Motor - EDM que analisa as áreas da motricidade fina e global, equilíbrio, esquema corporal, organização espacial e temporal/linguagem, e lateralidade. Essa criança parti...

Antibiotic-prescribing habits among Norwegian dentists: a survey over 25 years (1990-2015).

Science.gov (United States)

Preus, Hans R; Fredriksen, Karen W; Vogsland, Andrea E; Sandvik, Leiv; Grytten, Jostein I

2017-08-01

Bacterial antibiotic resistance is a steadily growing global problem, which today is compared with issues such as global warming, ozone depletion, and extinction of species. Consequently, calls come from global, Pan-European, and national authorities to gain insight into, limit, and stringently qualify the use of antibiotics in human and veterinary medicine, as well as in food production. Dentists are not considered to be frequent prescribers of antibiotics. However, few studies have identified how much, and in which situations, dentists prescribe such drugs. The aims of the present study were to survey Norwegian dentists' antibiotic-prescribing habits in 2015 and to compare the findings with previous studies (1990 and 2004) and with the actual numbers of dispensed prescriptions obtained from the 'Norwegian National Prescription Register'. The results from 1990 to 2004 show that there was a general increase in antibiotic prescriptions by Norwegian dentists, followed by a reduction or flattening of the prescription volume curve from 2004 to 2015. Despite this, possibilities for further improvements have been identified and recommendations given for targeted campaigns to reduce the prescription volume in dentistry by a further 30%, which has been ordered by the Norwegian National Assembly. © 2017 Eur J Oral Sci.

An overiew of non medical prescribing across one strategic health authority: a questionnaire survey

Directory of Open Access Journals (Sweden)

Courtenay Molly

2012-06-01

Full Text Available Abstract Background Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP has been implemented within organisations across a strategic health authority (SHA. The aim of the study was to provide an overview of NMP across one SHA. Methods NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7% participants responded. Data was collected between November 2010 and February 2011. Results The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6% compared to community practitioner prescribers (198 or 22.4%, pharmacist independent supplementary prescribers (35 or 4%, and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%. Nearly all (over 90% of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p  Conclusion NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and

An overiew of non medical prescribing across one strategic health authority: a questionnaire survey.

Science.gov (United States)

Courtenay, Molly; Carey, Nicola; Stenner, Karen

2012-06-01

Over 50,000 non-medical healthcare professionals across the United Kingdom now have prescribing capabilities. However, there is no evidence available with regards to the extent to which non-medical prescribing (NMP) has been implemented within organisations across a strategic health authority (SHA). The aim of the study was to provide an overview of NMP across one SHA. NMP leads across one SHA were asked to supply the email addresses of NMPs within their organisation. One thousand five hundred and eighty five NMPs were contacted and invited to complete an on-line descriptive questionnaire survey, 883 (55.7%) participants responded. Data was collected between November 2010 and February 2011. The majority of NMPs were based in primary care and worked in a team of 2 or more. Nurse independent supplementary prescribers were the largest group (590 or 68.6%) compared to community practitioner prescribers (198 or 22.4%), pharmacist independent supplementary prescribers (35 or 4%), and allied health professionals and optometrist independent and/or supplementary prescribers (8 or 0.9%). Nearly all (over 90%) of nurse independent supplementary prescribers prescribed medicines. Approximately a third of pharmacist independent supplementary prescribers, allied health professionals, and community practitioner prescribers did not prescribe. Clinical governance procedures were largely in place, although fewer procedures were reported by community practitioner prescribers. General practice nurses prescribed the most items. Factors affecting prescribing practice were: employer, the level of experience prior to becoming a non-medical prescriber, existence of governance procedures and support for the prescribing role (p < 0.001). NMP in this strategic health authority reflects national development of this relatively new role in that the majority of non-medical prescribers were nurses based in primary care, with fewer pharmacist and allied health professional prescribers. This

O texto teatral no desenvolvimento da oralidade em língua

Directory of Open Access Journals (Sweden)

Islia Cristina Vaz

2013-11-01

Full Text Available O seguinte trabalho, efetuado com o auxílio do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, tem como objetivo principal investigar a eficácia da utilização do texto teatral em sala de aula, auxiliando no desenvolvimento da oralidade em língua estrangeira. A principal motivação para que a presente pesquisa fosse realizada foi a percepção que se teve de um aparente medo de falar dos alunos que chegam ao nível intermediário do curso de francês. Como metodologia, foi utilizada a Pesquisa-Ação (BARBIER, 2007, juntamente com o auxílio das reflexões teóricas de Courtillon (2003, Schneuwly e Dolz (2010 e Reis (2008. Como material de pesquisa, foram feitas análises qualitativas dos diários de bordo recebidos dos alunos da Prática do Francês Oral e Escrito 4 (PFOE 4, na Universidade de Brasília (UnB, turma em que a experiência foi realizada.

O inseticida Thiodan® sobre o desenvolvimento folicular de lambaris

Directory of Open Access Journals (Sweden)

Lucas Marcon

2014-12-01

Full Text Available O Thiodan(r é um organoclorado a base de endosulfan que pode causar alterações morfológicas nos tecidos de peixes, dependendo da concentração e tempo de exposição. Este estudo teve como objetivo determinar a CL50-96h do Thiodan(r (endosulfan 350g L-1 para fêmeas de lambaris Astyanax bimaculatus em período de reprodução e analisar a morfologia do desenvolvimento folicular em diferentes concentrações do agrotóxico. Foram feitos quatro experimentos: 1 sem aclimatação e sem alimentação; 2 sem aclimatação e alimentados; 3 com aclimatação de 10 dias e sem alimentação; 4 com aclimatação de 10 dias e alimentados. A CL50-96h determinada foi de 13,6µg L-1, com intervalo de confiança de 10,1 a 18,4µg L-1 (P<0,05. Em todos os experimentos, foram utilizadas três concentrações diferentes do Thiodan(r inferiores à CL50-96h pré-determinada em laboratório de acordo com a NBR 15088 (ABNT, 2007. Os lambaris foram expostos ao Thiodan(r por 96 horas em três concentrações subletais de 1,15; 2,3 e 5,6µg L-1 e um grupo controle, livre de agrotóxico. Morfologicamente, percebeu-se que a ação do Thiodan(r nas concentrações subletais não alterou a morfologia do desenvolvimento folicular. Porém, o diâmetro folicular nos folículos secundários no experimento com aclimatação/com alimentação expostos ao Thiodan(r foi maior em relação ao grupo controle (P<0,05. Esses dados sugerem que a reprodução pode ser afetada pelo produto químico e pode causar comprometimento no desenvolvimento folicular

Observação do desenvolvimento de linguagem e funções auditiva e visual em lactentes

Directory of Open Access Journals (Sweden)

Lima Maria Cecília Marconi Pinheiro

2004-01-01

Full Text Available OBJETIVO: Investigar o desenvolvimento da linguagem e das funções auditiva e visual em lactentes de creche, a partir da avaliação realizada por educadores. MÉTODOS: Foram avaliados 115 lactentes, nos anos de 1998 a 2001, usuários de uma creche da área da saúde de uma universidade do Estado de São Paulo. Foi utilizado o "Protocolo da Observação do Desenvolvimento de Linguagem e das Funções Auditiva e Visual", com 39 provas no total, para a avaliação dos lactentes de 3 até 12 meses de idade. A aplicação desse Protocolo foi feita pelas educadoras da creche, devidamente treinadas. Utilizou-se o teste de Qui-quadrado ou Exato de Fisher. O nível de significância adotado foi de 5%. RESULTADOS: Os lactentes apresentaram um padrão diferente no desenvolvimento da linguagem quanto ao início do balbucio e das primeiras palavras, bem como na função visual, quanto à imitação e uso de jogos gestuais e de seguir ordem com uso de gestos. CONCLUSÕES: O ambiente creche propicia condições para um outro padrão de desenvolvimento de linguagem e das funções auditiva e visual. Ações de prevenção na creche devem integrar as áreas de saúde e educação num objetivo comum.

Does fire severity influence shrub resprouting after spring prescribed burning?

Science.gov (United States)

Fernández, Cristina; Vega, José A.; Fonturbel, Teresa

2013-04-01

Prescribed burning is commonly used to reduce the risk of severe wildfire. However, further information about the associated environmental effects is required to help forest managers select the most appropriate treatment. To address this question, we evaluated if fire severity during spring prescribed burning significantly affects the resprouting ability of two common shrub species in shrubland under a Mediterranean climate in NW Spain. Fire behaviour and temperatures were recorded in tagged individuals of Erica australis and Pterospartum tridentatum during prescribed burning. The number and length of resprouted shoots were measured three times (6, 12 and 18 months) after the prescribed burning. The influence of a series of fire severity indicators on some plant resprouting vigour parameters was tested by canonical correlation analysis. Six months and one year after prescribed burning, soil burn severity (measured by the absolute reduction in depth of the organic soil layer, maximum temperatures in the organic soil layer and the mineral soil surface during burning and the post-fire depth of the organic soil layer) reduced the resprouting vigour of E. australis and P. tridentatum. In contrast, direct measurements of fire effects on plants (minimum branch diameter, duration of temperatures above 300 °C in the shrub crown and fireline intensity) did not affect the post-fire plant vigour. Soil burn severity during spring prescribed burning significantly affected the short-term resprouting vigour in a mixed heathland in Galicia. The lack of effects eighteen months after prescribed burning indicates the high resilience of these species and illustrates the need to conciliate fire prevention and conservation goals.

Prescribed and self-reported seasonal training of distance runners.

Science.gov (United States)

Hewson, D J; Hopkins, W G

1995-12-01

A survey of 123 distance-running coaches and their best runners was undertaken to describe prescribed seasonal training and its relationship to the performance and self-reported training of the runners. The runners were 43 females and 80 males, aged 24 +/- 8 years (mean +/- S.D.), training for events from 800 m to the marathon, with seasonal best paces of 86 +/- 6% of sex- and age-group world records. The coaches and runners completed a questionnaire on typical weekly volumes of interval and strength training, and typical weekly volumes and paces of moderate and hard continuous running, for build-up, pre-competition, competition and post-competition phases of a season. Prescribed training decreased in volume and increased in intensity from the build-up through to the competition phase, and had similarities with 'long slow distance' training. Coaches of the faster runners prescribed longer build-ups, greater volumes of moderate continuous running and slower relative paces of continuous running (r = 0.19-0.36, P training close to competition pace. The mean training volumes and paces prescribed by the coaches were similar to those reported by the runners, but the correlations between prescribed and reported training were poor (r = 0.2-0.6). Coaches may therefore need to monitor their runners' training more closely.

Mudança e desenvolvimento organizacional do Banco Central do Equador: uma análise ecológica e uma proposta estratégica

OpenAIRE

Almeida Rueda, Carlos Elias

2010-01-01

Trata dos processos de mudança e desenvolvimento organizacional do Banco Central do Equador, tentando estabelecer um marco teórico referencial para a escolha de estratégias de desenvolvimento organizacional. Aborda as diversas teorias sobre organizações, tecnoburocracia, mu dança, inovação, deterioração e desenvolvimento organizacionais, estratégia, ambiente organizacional. Analisa as características principais da República do Equador e os paradigmas organizacionais do Banco Central ...

Can authorities appreciably enhance the prescribing of oral generic risperidone to conserve resources? Findings from across Europe and their implications.

Science.gov (United States)

Godman, Brian; Petzold, Max; Bennett, Kathleen; Bennie, Marion; Bucsics, Anna; Finlayson, Alexander E; Martin, Andrew; Persson, Marie; Piessnegger, Jutta; Raschi, Emanuel; Simoens, Steven; Zara, Corinne; Barbui, Corrado

2014-06-13

Generic atypical antipsychotic drugs offer health authorities opportunities for considerable savings. However, schizophrenia and bipolar disorders are complex diseases that require tailored treatments. Consequently, generally there have been limited demand-side measures by health authorities to encourage the preferential prescribing of generics. This is unlike the situation with hypertension, hypercholaesterolaemia or acid-related stomach disorders.The objectives of this study were to compare the effect of the limited demand-side measures in Western European countries and regions on the subsequent prescribing of risperidone following generics; to utilise the findings to provide future guidance to health authorities; and where possible, to investigate the utilisation of generic versus originator risperidone and the prices for generic risperidone. Principally, this was a segmented regression analysis of retrospective time-series data of the effect of the various initiatives in Belgium, Ireland, Scotland and Sweden following the introduction of generic risperidone. The study included patients prescribed at least one atypical antipsychotic drug up to 20 months before and up to 20 months after generic risperidone. In addition, retrospective observational studies were carried out in Austria and Spain (Catalonia) from 2005 to 2011 as well as one English primary care organisation (Bury Primary Care Trust (PCT)). There was a consistent steady reduction in risperidone as a percentage of total selected atypical antipsychotic utilisation following generics. A similar pattern was seen in Austria and Spain, with stable utilisation in one English PCT. However, there was considerable variation in the utilisation of generic risperidone, ranging from 98% of total risperidone in Scotland to only 14% in Ireland. Similarly, the price of generic risperidone varied considerably. In Scotland, generic risperidone was only 16% of pre-patent loss prices versus 72% in Ireland. Consistent

Drug prescribing pattern in three levels of health care facilities in the ...

African Journals Online (AJOL)

tabulation and goodness of fit. Results showed that there is significant statistical differences in the number of drugs prescribed per patient encounter, percentage of encounter with an injection prescribed, in adherence to WHO prescribing ...

Ibuprofen in paediatrics: pharmacology, prescribing and controversies.

Science.gov (United States)

Moriarty, Camilla; Carroll, Will

2016-12-01

Ibuprofen, a propionic acid derivative, is a non-steroidal anti-inflammatory drug. The oral formulation is widely used in paediatric practice and after paracetamol it is one of the most common drugs prescribed for children in hospital. The treatment of fever with antipyretics such as ibuprofen is controversial as fever is the normal response of the body to infection and unless the child becomes distressed or symptomatic, fever alone should not be routinely treated. Combined treatment with paracetamol and ibuprofen is commonly undertaken but almost certainly is not helpful. This article aims to describe the indications and mode of action of the drug, outline its pharmacokinetics and highlight the important key messages regarding its use in clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Guarda de filhos de mulheres presas e a ecologia do desenvolvimento humano

Directory of Open Access Journals (Sweden)

Claudia Stella

2015-11-01

Full Text Available In Brazil, when a mother is arrested, there are three possibilities to guard her young children: in shelter, in a foster family or in the prison nursery. The aim of this article is to revisit and engage with authors of human development, as Spitz, Bowlby and Bronfenbrenner, to understand the influences of imprisonment on children’s development and their guard possibilities. This article also draws on theoretical studies of the prison, as Foucault and Goffman, to advance the analysis of the ecology of human development and the prison environment. The mother-child separation, sudden or not, due to imprisonment and its possible impacts – as the change in the type of custody – can influence the children’s developmental environment, changing their relationship in the mother-child dyad and consequently force then to face ecological transitions that can affect their development. This article concluded that the prison environment carries a meaning of punishment and social segregation that interferes throughout the developmental process of children of women prisoners, inside the prison, and their guard processes, in shelters and foster families. No Brasil, quando uma mãe é presa, existem três possibilidades de guarda para seus filhos pequenos: em abrigo, em família substituta ou no berçário/creche do presídio. O objetivo deste artigo teórico é dialogar com autores do desenvolvimento humano, como Spitz, Bowlby e, especialmente, Bronfenbrenner, para entender as principais influências da prisão no desenvolvimento das crianças e nas suas possibilidades de guarda. Este artigo também apoia-se em teóricos dos estudos prisionais, como Foucault e Goffman, para avançar nas análises sobre a ecologia do desenvolvimento humano e o ambiente prisional. A separação mãe-filho, repentina ou não, em decorrência da prisão e de suas possíveis consequências – como a mudança no tipo de guarda da criança – pode influenciar o ambiente

Factors influencing pharmacists' adoption of prescribing: qualitative application of the diffusion of innovations theory.

Science.gov (United States)

Makowsky, Mark J; Guirguis, Lisa M; Hughes, Christine A; Sadowski, Cheryl A; Yuksel, Nese

2013-09-14

In 2007, Alberta became the first Canadian jurisdiction to grant pharmacists a wide range of prescribing privileges. Our objective was to understand what factors influence pharmacists' adoption of prescribing using a model for the Diffusion of Innovations in healthcare services. Pharmacists participated in semi-structured telephone interviews to discuss their prescribing practices and explore the facilitators and barriers to implementation. Pharmacists working in community, hospital, PCN, or other settings were selected using a mix of random and purposive sampling. Two investigators independently analyzed each transcript using an Interpretive Description approach to identify themes. Analyses were informed by a model explaining the Diffusion of Innovations in health service organizations. Thirty-eight participants were interviewed. Prescribing behaviours varied from non-adoption through to product, disease, and patient focused use of prescribing. Pharmacists' adoption of prescribing was dependent on the innovation itself, adopter, system readiness, and communication and influence. Adopting pharmacists viewed prescribing as a legitimization of previous practice and advantageous to instrumental daily tasks. The complexity of knowledge required for prescribing increased respectively in product, disease and patient focused prescribing scenarios. Individual adopters had higher levels of self-efficacy toward prescribing skills. At a system level, pharmacists who were in practice settings that were patient focused were more likely to adopt advanced prescribing practices, over those in product-focused settings. All pharmacists stated that physician relationships impacted their prescribing behaviours and individual pharmacists' decisions to apply for independent prescribing privileges. Diffusion of Innovations theory was helpful in understanding the multifaceted nature of pharmacists' adoption of prescribing. The characteristics of the prescribing model itself which

Variations in Metformin Prescribing for Type 2 Diabetes.

Science.gov (United States)

Goldberg, Tiffany; Kroehl, Miranda E; Suddarth, Kathleen Heist; Trinkley, Katy E

2015-01-01

Reasons for suboptimal metformin prescribing are unclear, but may be due to perceived risk of lactic acidosis. The purpose of this study is to describe provider attitudes regarding metformin prescribing in various patient situations. An anonymous, electronic survey was distributed electronically to 76 health care providers across the nation. The 14-item survey contained demographic questions and questions related to prescribing of metformin for T2DM in various patient situations, including suboptimal glycemic control, alcohol use, history of lactic acidosis, and varying degrees of severity for certain health conditions, including renal and hepatic dysfunction, chronic obstructive pulmonary disease, and heart failure. There were a total of 100 respondents. For suboptimal glycemic control, most providers (75%) would increase metformin from 1500 to 2000 mg daily; however, 25% would add an alternate agent, such as a sulfonylurea (18%) or dipeptidyl peptidase-4 inhibitor (7%). Although 51% of providers would stop metformin based on serum creatinine thresholds, the remainder would rely on glomerular filtration rate thresholds of <60 mL/min (15%), <30 mL/min (33%), or <15 mL/min (1%) to determine when to stop metformin. For heart failure, 45% of providers would continue metformin as currently prescribed regardless of severity. Most providers would adjust metformin for varying severity of hepatic dysfunction (74%) and alcohol abuse (40%). Despite evidence supporting the cardiovascular benefits of metformin, provider attitudes toward prescribing metformin are suboptimal in certain patient situations and vary greatly by provider. © Copyright 2015 by the American Board of Family Medicine.

Opioid Prescribing PSA (:60)

Centers for Disease Control (CDC) Podcasts

2017-07-06

This 60 second public service announcement is based on the July 2017 CDC Vital Signs report. Higher opioid prescribing puts patients at risk for addiction and overdose. Learn what can be done about this serious problem.  Created: 7/6/2017 by Centers for Disease Control and Prevention (CDC).   Date Released: 7/6/2017.

Operational use of prescribed fire in southern California chaparral

Science.gov (United States)

Ron Dougherty; Philip J. Riggan

1982-01-01

The use of prescribed fire in the chaparral could reduce the incidence and impacts of severe wildfires and enhance watershed re-sources. This paper describes the operational planning needed for a successful prescribed fire and discusses the recent experience with this technique on the Cleveland National Forest.

Perspectivas de desenvolvimento sustentável para o setor florestal na América Latina

Directory of Open Access Journals (Sweden)

Alexandre Grimaldi de Castro

1996-08-01

Full Text Available A proposta de desenvolvimento sustentado representa atualmente elemento de aprofundamento das discussões quanto ao real significado dos conceitos de progresso e desenvolvimento econômico e social. A premência por alternativas estabelecida a partir das crises ambiental e de recursos tem induzido a procura de estratégias que traduzam uma solução consistente de continuidade dos processo de desenvolvimento, sem que para isso ocorra o comprometimento da base de sustentação das atividades produtivas. As perspectivas de desenvolvimento sustentado para o setor de papel e celulose na América Latina, especificamente quanto às atividades de exploração florestal, estão intimamente relacionadas a dois aspectos fundamentais: estabelecimento de uma sistemática de negociação política entre o setor produtivo e demais representantes da sociedade; inserção dos empreendimentos dentro de uma escala mais ampla, na qual estes estejam plenamente integrados à programas de desenvolvimento regional multi-setoriais. Ademais, torna-se cada vez mais necessária a consideração de particularidades ambientais, sociais e políticas inerentes a determinado local/região. Especificamente quanto a economias e sociedades latino-americanas, o reconhecimento do contexto histórico de desenvolvimento regional constitui elemento fundamental de planejamento estratégico e de compreensão do contexto ambiental e político. O estado das artes em ciência e tecnologia, embora apresente um nível significativo de incerteza, permite a incorporação e desenvolvimento de novas estratégias de gerenciamento. A gestão ambiental, representada pelo gerenciamento de processos ambientais e produtivos de forma integrada, apresenta-se como alternativa viável de transição para um modelo de maior sustentabilidade. Programas de planejamento estratégico, aliados a sistemas dinâmicos de gerenciamento ambiental, constituem as ferramentas atualmente disponíveis para implementa

Cuidado ao desenvolvimento: intervenções de proteção ao desenvolvimento inicial de recém-nascidos pré-termo Developmental care: protection approach for early development of preterm infants

Directory of Open Access Journals (Sweden)

Cláudia Maria Gaspardo

2010-03-01

Full Text Available OBJETIVO: Revisar ensaios clínicos randomizados, publicados entre 2002 e 2009, sobre a eficácia de intervenções em Cuidado ao Desenvolvimento em recém-nascidos pré-termo em Unidade de Terapia Intensiva Neonatal. FONTES DE DADOS: Foram selecionados estudos randomizados dos bancos de dados Medline, PsycINFO, ISI Web of Science, LILACS e SciELO, usando-se as palavras-chave "developmental care" e "neonate". Realizou-se uma análise metodológica dos estudos, com base nos critérios: randomização, estimativa do tamanho amostral, perda amostral, critérios de inclusão e exclusão, controle de variáveis de confusão, validade dos instrumentos, condição "cega" do pesquisador, realização de seguimento, validades externa e ecológica e cuidados éticos. SÍNTESE DOS DADOS: As intervenções em Cuidado ao Desenvolvimento promoveram melhora em curto prazo nos resultados fisiológicos, comportamentais, neurológicos e clínicos dos recém-nascidos. Observou-se diminuição da reatividade à dor nos recém-nascidos durante procedimentos de pesagem e troca de fraldas. Os pais que receberam intervenções em Cuidado ao Desenvolvimento passaram a apresentar maior senso de competência para cuidar do recém-nascido. Os profissionais treinados em Cuidado ao Desenvolvimento demonstraram melhor desempenho na assistência ao recém-nascido e valorizaram mais os estímulos ambientais, físicos e sociais. CONCLUSÕES: Intervenções em Cuidado ao Desenvolvimento na Unidade de Terapia Intensiva Neonatal promoveram benefícios ao desenvolvimento e saúde dos recém-nascidos pré-termo no período neonatal e no primeiro ano de vida. Em estudos futuros, recomenda-se maior rigor metodológico no que se refere à condição de pesquisador "cego" em relação às intervenções e controle das variáveis de confusão. Estudos prospectivo-longitudinais são necessários para avaliar a eficácia das intervenções em médio e longo prazo no desenvolvimento

Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship.

Science.gov (United States)

Oliver, Stefanie Jane; Cush, James; Ward, Jeanette E

2017-01-01

To support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS) Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing. Finding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions) to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee. Prescribing recommendations in a regional Skin Infections Protocol had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60%) about AMS risks in community prescribing. If feasible, prescribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee. As AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform deliberations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional Skin Infections Protocol used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting.

Protocol: mixed-methods study to evaluate implementation, enforcement, and outcomes of U.S. state laws intended to curb high-risk opioid prescribing.

Science.gov (United States)

McGinty, Emma E; Stuart, Elizabeth A; Caleb Alexander, G; Barry, Colleen L; Bicket, Mark C; Rutkow, Lainie

2018-02-26

The U.S. opioid epidemic has been driven by the high volume of opioids prescribed by healthcare providers. U.S. states have recently enacted four types of laws designed to curb high-risk prescribing practices, such as high-dose and long-term opioid prescribing, associated with opioid-related mortality: (1) mandatory Prescription Drug Monitoring Program (PDMP) enrollment laws, which require prescribers to enroll in their state's PDMP, an electronic database of patients' controlled substance prescriptions, (2) mandatory PDMP query laws, which require prescribers to query the PDMP prior to prescribing an opioid, (3) opioid prescribing cap laws, which limit the dose and/or duration of opioid prescriptions, and (4) pill mill laws, which strictly regulate pain clinics to prevent nonmedical opioid prescribing. Some pain experts have expressed concern that these laws could negatively affect pain management among patients with chronic non-cancer pain. This paper describes the protocol for a mixed-methods study analyzing the independent effects of these four types of laws on opioid prescribing patterns and chronic non-cancer pain treatment, accounting for variation in implementation and enforcement of laws across states. Many states have enacted multiple opioid prescribing laws at or around the same time. To overcome this issue, our study focuses on 18 treatment states that each enacted a single law of interest, and no other potentially confounding laws, over a 4-year period (2 years pre-/post-law). Qualitative interviews with key leaders in each of the 18 treatment states will characterize the timing, scope, and strength of each state law's implementation and enforcement. This information will inform the design and interpretation of synthetic control models analyzing the effects of each of the two types of laws on two sets of outcomes: measures of (1) high-risk opioid prescribing and (2) non-opioid treatments for chronic non-cancer pain. Study of mandatory PDMP enrollment

Antibiotic prescribing practices for catheter urine culture results.

Science.gov (United States)

Chiu, Jonathan; Thompson, G William; Austin, Thomas W; Hussain, Zafar; John, Michael; Bombassaro, Anne Marie; Connelly, Sarah E; Elsayed, Sameer

2013-01-01

The literature suggests that positive results of catheter urine cultures frequently lead to unnecessary antimicrobial prescribing, which therefore represents an important target for stewardship. To assess the appropriateness of antibiotic prescribing in response to the results of urine cultures from patients with indwelling urinary catheters. This retrospective study was conducted at a tertiary care centre and involved adults with indwelling urinary catheters from whom urine specimens were obtained for culture. Patients with positive or negative culture results were identified from microbiology laboratory reports. The medical records of consecutive patients were screened to select a sample of 80 inpatients (40 per group). Abstracted patient histories were independently evaluated by an expert panel of 3 infectious diseases consultants blinded to the decisions of prescribers and of fellow panelists. The primary end point was concordance of each patient's treatment decision (with respect to the indication) between the expert panel (based on majority agreement, i.e., at least 2 of the 3 expert panelists) and the prescriber. The secondary end points were unnecessary days of therapy and selected outcomes over a predefined period after urine was obtained for culture. A total of 591 charts were screened to generate the targeted number of patients. Baseline demographic characteristics were comparable for the 2 groups, except antibiotic exposure before urine collection was significantly more frequent for the group with negative culture results. The treatment decision was concordant in 40% (16/40) of the patients with a positive culture result and 85% (34/40) of those with a negative culture result (p < 0.001). The most common reason for discordance was administration of antibiotics when not indicated (23 of 24 patients with a positive result and 5 of 6 patients with a negative result), which accounted for 165 and 32 unnecessary days of therapy per 1000 inpatient

Prescribing medical cannabis in Canada: Are we being too cautious?

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Lake, Stephanie; Kerr, Thomas; Montaner, Julio

2015-04-30

There has been much recent discussion and debate surrounding cannabis in Canada, including the prescribing of medical cannabis for therapeutic purposes. Certain commentators - including the Canadian Medical Association (CMA) - have denounced the prescribing of cannabis for medical purposes due to a perceived lack of evidence related to the drug's efficacy, harms, and mechanism of action. In this commentary, we present arguments in favour of prescribing medical cannabis in Canada. We believe the anti-cannabis position taken by CMA and other commentators is not entirely evidence-based. Using the example of neuropathic pain, we present and summarize the clinical evidence surrounding smoked or vapourized cannabis, including recent evidence pertaining to the effectiveness of cannabis in comparison to existing standard pharmacotherapies for neuropathy. Further, we outline how the concerns expressed regarding cannabis' mechanism of action are inconsistent with current decision-making processes related to the prescribing of many common pharmaceuticals. Finally, we discuss potential secondary public health benefits of prescribing cannabis for pain-related disorders in Canada and North America.

Association between respiratory prescribing, air pollution and deprivation, in primary health care.

Science.gov (United States)

Sofianopoulou, Eleni; Rushton, Stephen P; Diggle, Peter J; Pless-Mulloli, Tanja

2013-12-01

We investigated the association between respiratory prescribing, air quality and deprivation in primary health care. Most previous studies have used data from secondary and tertiary care to quantify air pollution effects on exacerbations of asthma and chronic obstructive pulmonary disease (COPD). However, these outcomes capture patients who suffer from relatively severe symptoms. This is a population-based ecological study. We analysed respiratory medication (salbutamol) prescribed monthly by 63 primary care practices, UK. Firstly, we captured the area-wide seasonal variation in prescribing. Then, using the area-wide variation in prescribing as an offset, we built a mixed-effects model to assess the remaining variation in relation to air quality and demographic variables. An increase of 10 μg/m(3) in ambient PM10 was associated with an increase of 1% (95% CI: 0.1-2%) in salbutamol prescribing. An increase of 1 SD in income and employment deprivation was associated with an increase of 20.5% (95% CI: 8.8-33.4%) and 14.7% (95% CI: 4.3-26.2%) in salbutamol prescribing rate, respectively. The study provides evidence that monthly respiratory prescribing in primary care is a useful indicator of the extent to which air pollution exacerbates asthma and COPD symptoms. Respiratory prescribing was higher on deprived populations.

Statin prescribing according to gender, age and indication

DEFF Research Database (Denmark)

Wallach-Kildemoes, Helle; Støvring, Henrik; Holme Hansen, Ebba

2016-01-01

RATIONALES, AIMS AND OBJECTIVES: The increasing dispensing of statins has raised concern about the appropriateness of prescribing to various population groups. We aimed to (1) investigate incident and prevalent statin prescribing according to indication, gender and age and (2) relate prescribing...... patterns to evidence on beneficial and adverse effects. METHODS: A cohort of Danish inhabitants (n = 4 424 818) was followed in nationwide registries for dispensed statin prescriptions and hospital discharge information. We calculated incidence rates (2005-2009), prevalence trends (2000-2010) and absolute...... numbers of statin users according to register proxies for indication, gender and age. RESULTS: In 2010, the prevalence became highest for ages 75-84 and was higher in men than women (37% and 33%, respectively). Indication-specific incidences and prevalences peaked at ages around 65-70, but in myocardial...

Curso de Pedagogia, desenvolvimento profissional e a profissionalização docente

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Nascimento Sousa Franc-Lane

2016-12-01

Full Text Available Neste artigo discutimos sobre as dificuldades provenientes da formação inicial em vista do desenvolvimento profissional e às possibilidades do curso de Pedagogia formar o professor na perspectiva do ensinar-aprender para trabalhar na Educação Infantil e anos iniciais do Ensino Fundamental. Partimos do seguinte problema de pesquisa: como o curso de Pedagogia está formando o professor para o ensinar-aprender tendo em vista a profissionalização docente. Como objetivo: analisar o processo formativo do curso de Pedagogia sobre a aprendizagem da docência evidenciando as percepções dos futuros professores sobre a sua profissão. Nesta pesquisa qualitativa, utilizamos como técnica a observação e como instrumento o questionário para os estudantes. Fundamentamo-nos em teóricos como: Marcelo Garcia (1999; Nóvoa (1995; Brandão e Dias (2014; Imbernón (2001; Libâneo (2004; Ramalho, Nuñez e Gauthier (2004; Nascimento (2015; entre outros. Os resultados da pesquisa apontam que o curso de Pedagogia está deixando a desejar na perspectiva da construção de saberes ou a consolidação do ensinar-aprender, relativos ao desenvolvimento profissional para a profissionalização docente. Entendemos que educação de qualidade exige a participação de um professor bem formado com as competências necessárias para transformar o discurso pedagógico em práxis. Sugerimos maior reflexão sobre a formação inicial, desenvolvimento profissional e o ensinar-aprender que colaboram com a profissionalização docente.

Evaluating Alternative Prescribed Burning Policies to Reduce Net Economic Damages from Wildfire

OpenAIRE

D. Evan Mercer; Jeffrey P. Prestemon; David T. Butry; John M. Pye

2007-01-01

We estimate a wildfire risk model with a new measure of wildfire output, intensity-weighted risk and use it in Monte Carlo simulations to estimate welfare changes from alternative prescribed burning policies. Using Volusia County, Florida as a case study, an annual prescribed burning rate of 13% of all forest lands maximizes net welfare; ignoring the effects on wildfire intensity may underestimate optimal rates of prescribed burning. Our estimated supply function for prescribed fire services ...

Ambiente institucional e compra de terras por estrangeiros em países em desenvolvimento

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Leandro Simões Pongeluppe

2014-03-01

Full Text Available De acordo com o Banco Mundial, desde o final dos anos 2000 o movimento de aquisição de terras por estrangeiros tem se acentuado nos países em desenvolvimento, impulsionado pelo boom dos preços das commodities. Em termos teóricos, a abordagem da Nova Economia Institucional (NEI argumenta que as instituições são importantes para as estratégias dos agentes econômicos e seu desempenho. Neste estudo, apoiado na NEI, pretende-se responder como as instituições presentes em países periféricos refletem o processo de aquisições de terras por investidores estrangeiros. Para esse objetivo, foram utilizados dados secundários de organizações internacionais, como Food and Agriculture Organization, Banco Mundial, Conferência das Nações Unidas sobre Comércio e Desenvolvimento, Fundo Monetário Internacional, Organização para a Cooperação Econômica e Desenvolvimento Econômico, Wall Street Journal e agências nacionais. A hipótese principal é que a força ou a fraqueza presente no ambiente institucional em países em desenvolvimento tem influência relevante no nível de Investimento Estrangeiro Direto (IED. Para testar a hipótese, adota-se como metodologia a análise estatística, na qual se verifica a relação entre o nível de IED nos países receptores (variável dependente contra variáveis independentes: liberdade de investimento, direitos de propriedade e nível de corrupção. Espera-se?que os pa?ses com?ambientes institucionais independentes: liberdade de investimento, direitos de propriedade e nível de corrupção. Espera-se que os países com ambientes institucionais fracos, ou menos seguros, tendam a receber menores investimentos em compra de terras e arrendamentos do que outros países que têm estrutura institucional que garanta os direitos de propriedade.

Pesquisa, desenvolvimento e inovação para o controle das doenças negligenciadas

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Fabiana Lícia Araújo dos Santos

2012-01-01

Full Text Available O fluxo contínuo de novos produtos no mercado é fruto da inovação tecnológica apresentada pela Indústria Farmacêutica. O governo Brasileiro tem investido em iniciativas promissoras de inovação através do desenvolvimento de medicamentos para os programas públicos de saúde, instituindo o Programa de Pesquisa e Desenvolvimento em Doenças Negligenciadas, o qual foca sete doenças: dengue, doenças de Chagas, leishmaniose, hanseníase, malária, esquistossomose e tuberculose. O artigo foca uma revisão sobre P&D aplicada à prevenção e controle das doenças negligenciadas no Brasil e no mundo. Com base nos dados levantados, percebeu-se que são grandes as dificuldades para o desenvolvimento de P&D em tecnologias e produtos para combater as doenças negligenciadas e que são poucos os investimentos financeiros nesse segmento quando comparados aos de pesquisas que focam outras enfermidades. Diante disso, pode-se enfatizar a importância de investimentos em pesquisas nesse setor, em saneamento básico e programas educativos que orientem a população sobre combate à proliferação dos vetores e agentes causadores.

Desenvolvimento profissional de docentes da educação superior em enfermagem: ressignificando experiências

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Magda de Mattos

2017-09-01

Full Text Available RESUMO: Este artigo é um recorte de uma pesquisa de doutorado que objetivou compreender o processo de desenvolvimento profissional docente de um grupo de enfermeiras a partir de sua inserção na educação superior. Para tanto, foram utilizados, como referenciais teóricos, os estudos que abordam a formação como desenvolvimento profissional docente, com foco nos conhecimentos e nas aprendizagens necessários à docência da educação superior. Os dados da pesquisa foram coletados e analisados considerando a abordagem qualitativa como pressuposto metodológico. Para a coleta dos dados, foram utilizadas narrativas orais de seis enfermeiras docentes de uma instituição pública federal de educação superior. Os resultados apontaram que se tornar docente da educação superior engendra um movimento contínuo e permanente de reflexão e ressignificações pessoais, profissionais, institucionais e organizacionais. Portanto, entende-se que um diálogo entre investigação, reflexão e formação docente pode conduzir a mudanças nas atitudes e nas práticas pedagógicas que fortalecem o desenvolvimento profissional docente.

A Validation Study of Homeopathic Prescribing and Patient Care Indicators

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Munmun Koley

2014-10-01

Full Text Available A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H, Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items and patient care indicators (5 items. Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791. The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations – Pearson's r from 0.58 (95% CI: 0.52-0.65 to 0.74 (95% CI: 0.69-0.78. The patient care indicators, except item 2, showed acceptable correlations – Pearson's r from 0.40 (95% CI: 0.31-0.48 to 0.82 (95% CI: 0.78-0.85. The instrument also showed high discriminant validity (prescribing indicators P<0.0001 and patient care indicators P<0.0001. Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development.

A Validation Study of Homeopathic Prescribing and Patient Care Indicators

Science.gov (United States)

Koley, Munmun; Saha, Subhranil; Ghosh, Shubhamoy; Nag, Goutam; Kundu, Monojit; Mondal, Ramkumar; Purkait, Rajib; Patra, Supratim

2014-01-01

A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H), Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items) and patient care indicators (5 items). Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791). The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations – Pearson's r from 0.58 (95% CI: 0.52-0.65) to 0.74 (95% CI: 0.69-0.78). The patient care indicators, except item 2, showed acceptable correlations – Pearson's r from 0.40 (95% CI: 0.31-0.48) to 0.82 (95% CI: 0.78-0.85). The instrument also showed high discriminant validity (prescribing indicators P < 0.0001 and patient care indicators P < 0.0001). Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development. PMID:25379474

Qualitative analysis of multi-disciplinary round-table discussions on the acceleration of benefits and data analytics through hospital electronic prescribing (ePrescribing) systems.

Science.gov (United States)

Cresswell, Kathrin; Coleman, Jamie; Smith, Pam; Swainson, Charles; Slee, Ann; Sheikh, Aziz

2016-07-04

Electronic systems that facilitate prescribing, administration and dispensing of medicines (ePrescribing systems) are at the heart of international efforts to improve the safety, quality and efficiency of medicine management. Considering the initial costs of procuring and maintaining ePrescribing systems, there is a need to better understand how to accelerate and maximise the financial benefits associated with these systems. We sought to investigate how different sectors are approaching the realisation of returns on investment from ePrescribing systems in U.K. hospitals and what lessons can be learned for future developments and implementation strategies within healthcare settings. We conducted international, multi-disciplinary, round-table discussions with 21 participants from different backgrounds including policy makers, healthcare organisations, academic researchers, vendors and patient representatives. The discussions were audio-recorded, transcribed and then thematically analysed with the qualitative analysis software NVivo10. There was an over-riding concern that realising financial returns from ePrescribing systems was challenging. The underlying reasons included substantial fixed costs of care provision, the difficulties in radically changing the medicines management process and the lack of capacity within NHS hospitals to analyse and exploit the digital data being generated. Any future data strategy should take into account the need to collect and analyse local and national data (i.e. within and across hospitals), setting comparators to measure progress (i.e. baseline measurements) and clear standards guiding data management so that data are comparable across settings. A more coherent national approach to realising financial benefits from ePrescribing systems is needed as implementations progress and the range of tools to collect information will lead to exponential data growth. The move towards more sophisticated closed-loop systems that integrate

Qualitative analysis of multi-disciplinary round-table discussions on the acceleration of benefits and data analytics through hospital electronic prescribing (ePrescribing systems

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Kathrin Cresswell

2016-07-01

Full Text Available Background: Electronic systems that facilitate prescribing, administration and dispensing of medicines (ePrescribing systems are at the heart of international efforts to improve the safety, quality and efficiency of medicine management. Considering the initial costs of procuring and maintaining ePrescribing systems, there is a need to better understand how to accelerate and maximise the financial benefits associated with these systems. Objectives: We sought to investigate how different sectors are approaching the realisation of returns on investment from ePrescribing systems in U.K. hospitals and what lessons can be learned for future developments and implementation strategies within healthcare settings. Methods: We conducted international, multi-disciplinary, round-table discussions with 21 participants from different backgrounds including policy makers, healthcare organisations, academic researchers, vendors and patient representatives. The discussions were audio-recorded, transcribed and then thematically analysed with the qualitative analysis software NVivo10. Results: There was an over-riding concern that realising financial returns from ePrescribing systems was challenging. The underlying reasons included substantial fixed costs of care provision, the difficulties in radically changing the medicines management process and the lack of capacity within NHS hospitals to analyse and exploit the digital data being generated. Any future data strategy should take into account the need to collect and analyse local and national data (i.e. within and across hospitals, setting comparators to measure progress (i.e. baseline measurements and clear standards guiding data management so that data are comparable across settings. Conclusions: A more coherent national approach to realising financial benefits from ePrescribing systems is needed as implementations progress and the range of tools to collect information will lead to exponential data growth. The

Espaço, cidades e escalas territoriais: novas implicações de políticas de desenvolvimento regional

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Ana Carolina da Cruz Lima

2014-04-01

Full Text Available O papel do espaço no processo de desenvolvimento socioeconômico constitui um objeto de estudo bastante complexo. Os teóricos da Escola Francesa de Sociologia Urbana elaboraram uma série de estudos nesta área com o intuito de esclarecer as relações entre a forma espacial e os processos sociais. O objetivo do artigo é destacar os principais argumentos desta Escola de Pensamento, o papel desempenhado pelas cidades neste processo e as principais recomendações de políticas de desenvolvimento que surgem a partir de então. A análise sugere que as escalas territoriais tornam-se fundamentais para a dinâmica das economias nacionais, o que lhes concede papel de destaque como objeto de política: medidas intervencionistas devem ser combinadas nas diversas escalas territoriais, considerando a localidade como parte do todo. É preciso repensar a espacialidade, o que contribuirá para o desenvolvimento socioeconômico integrado.

GPs' decision-making when prescribing medicines for breastfeeding women: Content analysis of a survey

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Amir Lisa H

2010-03-01

Full Text Available Abstract Background Many breastfeeding women seek medical care from general practitioners (GPs for various health problems and GPs may consider prescribing medicines in these consultations. Prescribing medicines to a breastfeeding mother may lead to untimely cessation of breastfeeding or a breastfeeding mother may be denied medicines due to the possible risk to her infant, both of which may lead to unwanted consequences. Information on factors governing GPs' decision-making and their views in such situations is limited. Methods GPs providing shared maternity care at the Royal Women's Hospital, Melbourne were surveyed using an anonymous postal survey to determine their knowledge, attitudes and practices on medicines and breastfeeding, in 2007/2008 (n = 640. Content analysis of their response to a question concerning decision-making about the use of medicine for a breastfeeding woman was conducted. A thematic network was constructed with basic, organising and global themes. Results 335 (52% GPs responded to the survey, and 253 (76% provided information on the last time they had to decide about the use of medicine for a breastfeeding woman. Conditions reported were mastitis (24%, other infections (24% and depressive disorders (21%. The global theme that emerged was "complexity of managing risk in prescribing for breastfeeding women". The organising themes were: certainty around decision-making; uncertainty around decision-making; need for drug information to be available, consistent and reliable; joint decision-making; the vulnerable "third party" and infant feeding decision. Decision-making is a spectrum from a straight forward decision, such as treatment of mastitis, to a complicated one requiring multiple inputs and consideration. GPs use more information seeking and collaboration in decision-making when they perceive the problem to be more complex, for example, in postnatal depression. Conclusion GPs feel that prescribing medicines for

Prescription drug abuse communication: A qualitative analysis of prescriber and pharmacist perceptions and behaviors.

Science.gov (United States)

Hagemeier, Nicholas E; Tudiver, Fred; Brewster, Scott; Hagy, Elizabeth J; Hagaman, Angela; Pack, Robert P

Interpersonal communication is inherent in a majority of strategies seeking to engage prescriber and pharmacist health care professionals (HCPs) in the reduction and prevention of prescription drug abuse (PDA). However, research on HCP PDA communication behavioral engagement and factors that influence it is limited. This study quantitatively examined communication behaviors and trait-level communication metrics, and qualitatively described prescription drug abuse-related communication perceptions and behaviors among primary care prescribers and community pharmacists. Five focus groups (N = 35) were conducted within the Appalachian Research Network (AppNET), a rural primary care practice-based research network (PBRN) in South Central Appalachia between February and October, 2014. Focus groups were structured around the administration of three previously validated trait-level communication survey instruments, and one instrument developed by the investigators to gauge HCP prescription drug abuse communication engagement and perceived communication importance. Using a grounded theory approach, focus group themes were inductively derived and coded independently by study investigators. Member-checking interviews were conducted to validate derived themes. Respondents' trait-level communication self-perceptions indicated low communication apprehension, high self-perceived communication competence, and average willingness to communicate as compared to instrument specific criteria and norms. Significant variation in HCP communication behavior engagement was noted specific to PDA. Two overarching themes were noted for HCP-patient communication: 1) influencers of HCP communication and prescribing/dispensing behaviors, and 2) communication behaviors. Multiple sub-themes were identified within each theme. Similarities were noted in perceptions and behaviors across both prescribers and pharmacists. Despite the perceived importance of engaging in PDA communication, HCPs reported

Desenvolvimento, globalização e trabalho decente

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Ronaldo Baltar

Full Text Available O objetivo do artigo é discutir alguns desafios para o projeto brasileiro de desenvolvimento, baseado no consumo de massas dos três últimos Planos Plurianuais, que consiste na busca de equacionamento entre a ampliação da renda nacional através do trabalho, com aumento da empregabilidade e eliminação da precarização do trabalho. A pesquisa procura avaliar e comparar alguns indicadores sobre qualidade no emprego formal, tal como definido pela proposta da Organização Internacional do Trabalho (OIT para a Agenda do Trabalho Decente, em conjunto com dados que mostram a trajetória de inserção do Brasil no comércio internacional. O estudo levanta questões sobre as possibilidades de se garantir uma política de maior inserção no processo de globalização e, ao mesmo tempo, rever as consequências diretas da internacionalização da produção e do comércio sobre a qualidade do trabalho e a geração de renda. O texto conclui apontando que a formação de uma política de desenvolvimento centrada na ampliação do mercado interno, com propostas de expansão do consumo de massas, requer a definição de metas, não apenas de empregabilidade, mas voltadas à formação de empregos que atendam aos direitos fundamentais dos trabalhadores, seguindo os parâmetros da Agenda do Trabalho Decente.

Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship

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Stefanie Jane Oliver

2017-07-01

Full Text Available BackgroundTo support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing.What we didFinding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee.What we learnedPrescribing recommendations in a regional Skin Infections Protocol had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60% about AMS risks in community prescribing. If feasible, prescribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee.Strengthening AMS in remote settingsAs AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform deliberations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional Skin Infections Protocol used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting.

DESENVOLVIMENTO DE MUDAS DE REPOLHO EM DIFERENTES BANDEJAS COM SUPLEMENTAÇÃO ORGÂNICA NO SUBSTRATO COMERCIAL

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Mário Pechara Jaeggi

2017-04-01

Full Text Available Objetivou-se com este trabalho avaliar diferentes tipos de bandejas e concentrações de substratos sobre o desenvolvimento de mudas de repolho. O delineamento experimental utilizado foi o inteiramente casualizado  em um esquema fatorial 2x5, sendo dois tipos de bandejas e cinco concentrações de substratos, com cinco repetições. Os tratamentos foram constituídos por duas bandejas de poliestireno (128 e 200 células e  cinco concentrações de substratos (100/0; 75/25; 50/50; 25/75 e 0/100. Ao 31° dia após semeadura foram avaliadas as seguintes variáveis: altura total da planta; altura da parte aérea, massa seca total e massa seca parte aérea. De acordo com os resultados, a bandeja de 128 células proporcionou melhor desenvolvimento e relação a bandeja 200 células. O substrato vermicomposto na concentração de 0/100% proporcionou melhor desenvolvimento para todas as características avaliadas

Diretrizes para o desenvolvimento e a avaliação de blogs de biblioteca

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Laura Akie Saito Inafuko

2012-01-01

Full Text Available Os blogs se popularizam pela facilidade de uso e publicação, influenciando no aumento de ambientes informacionais digitais. Considera-se necessário estudos que otimizem a organização das informações contidas em blogs, para contribuir no seu desenvolvimento. A partir de observação direta não-participativa, analisou-se em 6 blogs de bibliotecas universitárias elementos de AI (MORVILLE; ROSENFELD, 2006 e diretrizes de Usabilidade (NIELSEN, 2005, identificando-se os elementos fundamentais e opcionais para o desenvolvimento estrutural de um blog. Além disso, foram elaboradas diretrizes de planejamento, um modelo de avaliação, e foram propostos elementos de AI específicos para blogs, contribuindo para os estudos da AI Digital.

Differential impact of two risk communications on antipsychotic prescribing to people with dementia in Scotland: segmented regression time series analysis 2001-2011.

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Guthrie, Bruce; Clark, Stella A; Reynish, Emma L; McCowan, Colin; Morales, Daniel R

2013-01-01

Regulatory risk communications are an important method for disseminating drug safety information, but their impact varies. Two significant UK risk communications about antipsychotic use in older people with dementia were issued in 2004 and 2009. These varied considerably in their content and dissemination, allowing examination of their differential impact. Segmented regression time-series analysis 2001-2011 for people aged ≥65 years with dementia in 87 Scottish general practices, examining the impact of two pre-specified risk communications in 2004 and 2009 on antipsychotic and other psychotropic prescribing. The percentage of people with dementia prescribed an antipsychotic was 15.9% in quarter 1 2001 and was rising by an estimated 0.6%/quarter before the 2004 risk communication. The 2004 risk communication was sent directly to all prescribers, and specifically recommended review of all patients prescribed relevant drugs. It was associated with an immediate absolute reduction in antipsychotic prescribing of 5.9% (95% CI -6.6 to -5.2) and a change to a stable level of prescribing subsequently. The 2009 risk communication was disseminated in a limited circulation bulletin, and only specifically recommended avoiding initiation if possible. There was no immediate associated impact, but it was associated with a significant decline in prescribing subsequently which appeared driven by a decline in initiation, with the percentage prescribed an antipsychotic falling from 18.4% in Q1 2009 to 13.5% in Q1 2011. There was no widespread substitution of antipsychotics with other psychotropic drugs. The two risk communications were associated with reductions in antipsychotic use, in ways which were compatible with marked differences in their content and dissemination. Further research is needed to ensure that the content and dissemination of regulatory risk communications is optimal, and to track their impact on intended and unintended outcomes. Although rates are falling

By Default: The Effect of Prepopulated Prescription Quantities on Opioid Prescribing in the Emergency Department.

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Santistevan, Jamie R; Sharp, Brian R; Hamedani, Azita G; Fruhan, Scott; Lee, Andrew W; Patterson, Brian W

2018-03-01

Opioid prescribing patterns have come under increasing scrutiny with the recent rise in opioid prescriptions, opioid misuse and abuse, and opioid-related adverse events. To date, there have been limited studies on the effect of default tablet quantities as part of emergency department (ED) electronic order entry. Our goal was to evaluate opioid prescribing patterns before and after the removal of a default quantity of 20 tablets from ED electronic order entry. We performed a retrospective observational study at a single academic, urban ED with 58,000 annual visits. We identified all adult patients (18 years or older) seen in the ED and discharged home with prescriptions for tablet forms of hydrocodone and oxycodone (including mixed formulations with acetaminophen). We compared the quantity of tablets prescribed per opioid prescription 12 months before and 10 months after the electronic order-entry prescription default quantity of 20 tablets was removed and replaced with no default quantity. No specific messaging was given to providers, to avoid influencing prescribing patterns. We used two-sample Wilcoxon rank-sum test, two-sample test of proportions, and Pearson's chi-squared tests where appropriate for statistical analysis. A total of 4,104 adult patients received discharge prescriptions for opioids in the pre-intervention period (151.6 prescriptions per 1,000 discharged adult patients), and 2,464 post-intervention (106.69 prescriptions per 1,000 discharged adult patients). The median quantity of opioid tablets prescribed decreased from 20 (interquartile ration [IQR] 10-20) to 15 (IQR 10-20) (pdefault quantity. While the most frequent quantity of tablets received in both groups was 20 tablets, the proportion of patients who received prescriptions on discharge that contained 20 tablets decreased from 0.5 (95% confidence interval [CI] [0.48-0.52]) to 0.23 (95% CI [0.21-0.24]) (pdefault quantity removal. Although the median number of tablets differed significantly

Atividades extensionistas, promoção da saúde e desenvolvimento sustentável: experiência de um grupo de pesquisa em enfermagem

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Siqueira, Samylla Maira Costa; Jesus, Viviane Silva de; Santos, Elane Nayara Batista dos; Whitaker, Maria Carolina Ortiz; Sousa, Brendo Vitor Nogueira; Camargo, Climene Laura de

2017-01-01

Resumo Introdução: A extensão universitária é uma forma de interação entre a universidade e a comunidade, e, a partir dela, é possível desenvolver atividades de promoção da saúde, a exemplo do desenvolvimento sustentável de comunidades vulneráveis. Objetivo: Relatar a experiência de um grupo de pesquisa no desenvolvimento de atividades de extensão em enfermagem para a promoção da saúde e desenvolvimento sustentável de comunidades quilombolas. Métodos: Trata-se de um estudo descritivo, do t...

Utilization of a clinical microbiology service at a Cambodian paediatric hospital and its impact on appropriate antimicrobial prescribing.

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Fox-Lewis, Shivani; Pol, Sreymom; Miliya, Thyl; Day, Nicholas P J; Turner, Paul; Turner, Claudia

2018-02-01

Antimicrobial resistance threatens human health worldwide. Antimicrobial misuse is a major driver of resistance. Promoting appropriate antimicrobial use requires an understanding of how clinical microbiology services are utilized, particularly in resource-limited settings. To assess the appropriateness of antimicrobial prescribing and the factors affecting utilization of the established clinical microbiology service (CMS). The CMS comprises the microbiology laboratory, clinical microbiologists (infection doctors) and antimicrobial treatment guidelines. This mixed-methods study was conducted at a non-governmental Cambodian paediatric hospital. Empirical and post-culture antimicrobial prescriptions were reviewed from medical records. The random sample included 10 outpatients per week in 2016 (retrospective) and 20 inpatients per week for 4 weeks in the medical, neonatal and intensive care wards (prospective). Post-culture prescriptions were assessed in patients with positive blood and cerebrospinal fluid cultures from 1 January 2014 to 31 December 2016. Focus group discussions and semi-structured interviews with clinicians explored barriers and facilitators to use of the CMS. Only 31% of outpatients were prescribed empirical antimicrobials. Post-culture prescriptions (394/443, 89%) were more likely to be appropriate than empirical prescriptions (447/535, 84%), based on treatment guidelines, microbiology advice and antimicrobial susceptibility test results (P = 0.015). Being comprehensive, accessible and trusted enabled CMS utilization. Clinical microbiologists provided a crucial human interface between the CMS and physicians. The main barriers were a strong clinical hierarchy and occasional communication difficulties. Antimicrobial prescribing in this hospital was largely appropriate. A culturally appropriate human interface linking the laboratory and physicians is essential in providing effective microbiology services and ensuring appropriate antimicrobial

Safer Prescribing and Care for the Elderly (SPACE): feasibility of audit and feedback plus practice mail-out to patients with high-risk prescribing.

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Wallis, Katharine; Tuckey, Rebecca

2017-06-01

INTRODUCTION High-risk prescribing in general practice is common and places patients at increased risk of adverse events. AIM The Safer Prescribing and Care for the Elderly (SPACE) intervention, comprising audit and feedback plus practice mail-out to patients with high-risk prescribing, was designed to promote medicines review and support safer prescribing. This study aims to test the SPACE intervention feasibility in general practice. METHODS This feasibility study involved an Auckland Primary Health Organisation (PHO), a clinical advisory pharmacist, two purposively sampled urban general practices, and seven GPs. The acceptability and utility of the SPACE intervention were assessed by semi- structured interviews involving study participants, including 11 patients with high-risk prescribing. Interviews were audio-recorded, transcribed verbatim and analysed using a general inductive approach to identify emergent themes. RESULTS The pharmacist said the SPACE intervention facilitated communication with GPs, and provided a platform for their clinical advisory role at no extra cost to the PHO. GPs said the feedback session with the pharmacist was educational but added to time pressures. GPs selected 29 patients for the mail-out. Some GPs were concerned the mail-out might upset patients, but patients said they felt cared for. Some patients intended to take the letter to their next appointment and discuss their medicines with their GP; others said there were already many things to discuss and not enough time. Some patients were confused by the medicines information brochure. DISCUSSION The SPACE intervention is feasible in general practice. The medicines information brochure needs simplification. Further research is needed to test the effect of SPACE on high-risk prescribing.

Stakeholders' views on granting prescribing authority to pharmacists in Nigeria: a qualitative study.

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Auta, Asa; Strickland-Hodge, Barry; Maz, Julia

2016-08-01

Background In Nigeria, only medical doctors, dentists and some nurses in primary care facilities have the legal right to prescribe medicines to patients. Patients' access to prescription medicines can be seriously affected by the shortage of prescribers leading to longer waiting times in hospitals. Objective This research was carried out to investigate stakeholders' views on granting prescribing authority to pharmacists in Nigeria. Setting The study was conducted in Nigeria. Methods Qualitative, semi-structured interviews were conducted with 43 Nigerian stakeholders including policymakers, pharmacists, doctors and patient group representatives. Transcribed interviews were entered into the QSR NVivo 10 software and analysed using a thematic approach. Main outcome measure Stakeholders' perception on the granting of prescribing authority to pharmacists in Nigeria. Results Three major themes emerged from the interviews: (1) prescribing as a logical role for pharmacists, (2) pharmacist prescribing- an opportunity or a threat and (3) the potential barriers to pharmacist prescribing. Many non-medical stakeholders including pharmacists and patient group representatives supported an extended role for pharmacists in prescribing while the majority of medical doctors including those in policy making were reluctant to do so. Generally, all stakeholders perceived that pharmacist prescribing represents an opportunity to increase patients' access to medicines, reduce doctors' workload and promote the utilisation of pharmacists' skills. However, many stakeholders including pharmacists and doctors commonly identified pharmacists' inadequate skills in diagnosis, medical resistance and shortage of pharmacists as potential barriers to the introduction of pharmacist prescribing in Nigeria. Conclusion The present study showed a split of opinion between participants who were medical doctors and those who were non-doctors in their support for pharmacist prescribing. However, all

Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

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Hanna T

2014-03-01

Full Text Available Objective: To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods: Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG by three expert researchers. Results: In seven of nine scenarios (78%, the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency in the majority of scenarios. Due to this, only 47% (76/162 of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162 of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusion: Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.

Using scenarios to test the appropriateness of pharmacist prescribing in asthma management.

Science.gov (United States)

Hanna, Tamer; Bajorek, Beata; Lemay, Kate; Armour, Carol L

2014-01-01

To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists' confidence, and appropriateness, in the context of asthma management. Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way.

Using scenarios to test the appropriateness of pharmacist prescribing in asthma management

Science.gov (United States)

Hanna, Tamer; Bajorek, Beata; LeMay, Kate; Armour, Carol L.

Objective To explore the potential for community pharmacist prescribing in terms of usefulness, pharmacists’ confidence, and appropriateness, in the context of asthma management. Methods Twenty community pharmacists were recruited using convenience sampling from a group of trained practitioners who had already delivered asthma services. These pharmacists were asked to complete a scenario-based questionnaire (9 scenarios) modelled on information from real patients. Pharmacist interventions were independently reviewed and rated on their appropriateness according to the Respiratory Therapeutic Guidelines (TG) by three expert researchers. Results In seven of nine scenarios (78%), the most common prescribing intervention made by pharmacists agreed with TG recommendations. Although the prescribing intervention was appropriate in the majority of cases, the execution of such interventions was not in line with guidelines (i.e. dosage or frequency) in the majority of scenarios. Due to this, only 47% (76/162) of the interventions overall were considered appropriate. However, pharmacists were deemed to be often following common clinical practice for asthma prescribing. Therefore 81% (132/162) of prescribing interventions were consistent with clinical practice, which is often not guideline driven, indicating a need for specific training in prescribing according to guidelines. Pharmacists reported that they were confident in making prescribing interventions and that this would be very useful in their management of the patients in the scenarios. Conclusions Community pharmacists may be able to prescribe asthma medications appropriately to help achieve good outcomes for their patients. However, further training in the guidelines for prescribing are required if pharmacists are to support asthma management in this way. PMID:24644524

COPA DO MUNDO 2014: TURISMO, DESENVOLVIMENTO E SUSTENTABILIDADE NA CONTEMPORANEIDADE

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Luciana Hoppe

2015-08-01

Full Text Available A atividade turística é um dos fenômenos mais significativos da contemporaneidade e cada vez mais tem se tornado objeto de pesquisas e estudos tanto no âmbito das ciências sociais aplicadas quanto das ciências humanas. Atenção essa que ganha vulto em função da complexa estrutura de serviços que envolve e, também, em razão do impacto que o turismo tem no cotidiano daquelas populações que habitam as cidades receptoras. Neste sentido, um dos modos pelos quais o turismo toma forma é aquele ligado aos eventos, em especial aos denominados megaeventos. Diante disso, este estudo busca refletir sobre a Copa do Mundo de 2014 realizada no Brasil no sentido de colaborar com a discussão acadêmica sobre megaeventos, seus impactos e desdobramentos no âmbito de uma perspectiva sinérgica entre desenvolvimento e sustentabilidade. Assim, defende-se no texto o argumento de que muitas são as formas como o turismo impacta na vida das pessoas e no interior das relações cotidianas daqueles que vivem nas cidades receptoras ganhando, assim, tangibilidade e concretude. Palavras-chave: Turismo. Desenvolvimento. Sustentabilidade. Megaevento. Copa do Mundo.

Is Customization in Antidepressant Prescribing Associated with Acute-Phase Treatment Adherence?

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Merrick, Elizabeth L; Hodgkin, Dominic; Panas, Lee; Soumerai, Stephen B; Ritter, Grant

2012-03-01

OBJECTIVES: The objective was to explore whether prescribing variation is associated with duration of antidepressant use during the acute phase of treatment. Improving quality of care and increasing the extent to which treatment is patient-centered and customized are interrelated goals. Prescribing variation may be considered a marker of customization, and could be associated with better antidepressant treatment adherence. METHODS: A cross-sectional secondary data analysis examining the association between providers' antidepressant prescribing variation and patient continuity of antidepressant treatment. The data source was two states' Medicaid claims for dual-eligible Medicaid/Medicare patients. The sample included 383 patients with new episodes of antidepressant treatment, representing 70 providers with at least four patients in the sample. We tested two alternate measures of prescribing concentration: 1) share of prescriber's initial antidepressant prescribing accounted for by the two most common regimens, and 2) Herfindahl index. The HEDIS performance measure of effective acute-phase treatment (at least 84 out of 114 days with antidepressant) was the dependent variable. KEY FINDINGS: In multivariate analyses, the concentration measure based on the top two regimens was significant and inversely related to duration adequacy (p customized care.

General practitioner attitudes towards prescribing aspirin to carriers of Lynch Syndrome: findings from a national survey.

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Smith, Samuel G; Foy, Robbie; McGowan, Jennifer; Kobayashi, Lindsay C; Burn, John; Brown, Karen; Side, Lucy; Cuzick, Jack

2017-10-01

A dose non-inferiority study comparing 100 mg, 300 mg and 600 mg of aspirin for cancer prevention among Lynch Syndrome carriers is underway (Colorectal Adenoma/Carcinoma Prevention Programme trial 3, CaPP3). To guide implementation of the findings, we investigated general practitioner (GP) attitudes towards aspirin prescribing for Lynch Syndrome carriers. We surveyed 1007 UK GPs (9.6% response rate). Using a within-subjects design, GPs read a statement on harms and benefits of aspirin and indicated their willingness to prescribe aspirin at three doses (100 mg, 300 mg, 600 mg). Approximately two-thirds (70.8%) of GPs had heard of Lynch Syndrome or its associated names, and among those 46.7% were aware of the cancer preventive effects of aspirin among carriers. Two-thirds (68.1%) of GPs reported feeling comfortable discussing harms and benefits of aspirin with a Lynch Syndrome patient. Willingness to prescribe was 91.3% at 100 mg, and declined to 81.8% at 300 mg and 62.3% at 600 mg (p Lynch Syndrome patient in practice (OR 1.44, 95% CI 1.01-2.05, p = 0.045). GPs report limited awareness of Lynch Syndrome and the preventive effects of aspirin among carriers. To ensure the optimal dose identified in the CaPP3 trial is readily available to patients, prescribing guidance and strategies to educate GPs should be developed.

Topical antibiotic monotherapy prescribing practices in acne vulgaris.

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Hoover, William D; Davis, Scott A; Fleischer, Alan B; Feldman, Steven R

2014-04-01

The aim of this study is to evaluate the frequency of dosing topical antibiotics as monotherapy in the treatment of acne vulgaris, and physician specialty prescribing these medications. This study is a retrospective review of all visits with a sole diagnosis of acne vulgaris (ICD-9-CM code 706.1) found on the National Ambulatory Medical Care Survey (NAMCS) in 1993-2010. We recorded the number of visits surveyed where acne vulgaris was the sole diagnosis, number of visits where topical antibiotics were the only treatment prescribed, and the specialty of physician in each encounter. Topical erythromycin or clindamycin were the sole medication prescribed in 0.81% of the visits recorded, with 60% of these prescriptions arising from dermatologists and 40% from non-dermatologists. The trend of prescribing topical antibiotic monotherapy is declining (p acnes to topical antibiotic regimens has led to the need to re-evaluate the use of topical antibiotics in the treatment of acne vulgaris. While the rate of topical antibiotic monotherapy is declining, their use should be reserved for situations where the direct need for antibiotics arises. If a clinician feels that antibiotics are a necessary component to acne therapy, they should be used as part of a combination regimen.

Competência Tradutória: o desenvolvimento da subcompetência sobre conhecimentos em tradução

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Tania Liparini

2017-12-01

Full Text Available Este artigo apresenta um recorte do projeto Competência Tradutória e Formação de Tradutores: o desenvolvimento das subcompetências específicas do tradutor (CNPq 485158/2013-2, cujo objetivo é investigar o desenvolvimento da competência tradutória em um grupo de tradutores em formação, a partir de um estudo longitudinal de abordagem processual. Serão discutidos aqui os resultados – obtidos na primeira e segunda etapa do projeto – relativos ao desenvolvimento da subcompetência sobre conhecimentos em tradução. Para a coleta e análise dos dados sobre conhecimentos em tradução, seguimos a metodologia de PACTE (2008. Esses dados foram cruzados com a avaliação da qualidade das traduções, realizada com base nos critérios de PACTE (2011b e na ferramenta de avaliação Translation Quality Assessment Tool (Colina, 2008. Os resultados obtidos até o momento apontam para o progresso no desenvolvimento da subcompetência sobre conhecimentos em tradução dos sujeitos, no período compreendido entre a primeira e a segunda etapa da coleta de dados. A pesquisa se encontra em andamento; espera-se, ao final do projeto, além de confirmar os resultados obtidos até o momento, contribuir para ampliar os conhecimentos sobre aquisição da competência tradutória e fomentar reflexões que levem a melhorias no ensino de tradução.

Desenvolvimento inicial de Erythrina velutina sob restrição hídrica

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Mychelle Karla Teixeira de Oliveira

2017-01-01

Full Text Available Erythrina velutina Willd. é uma espécie arbórea, nativa do nordeste brasileiro, utilizada como ornamental e empregada em programas de reflorestamento. Neste contexto, o objetivo deste trabalho foi obter informações sobre o desenvolvimento de E. velutina sob restrição hídrica. O experimento foi conduzido em delineamento inteiramente casualizado, em parcelas subdivididas no tempo, com quatro repetições. Foram utilizados dois manejos de irrigação (sem e com estresse hídrico. Aos 56 dias após o transplantio, as mudas foram submetidas por 14 dias completos de restrição hídrica. Ao longo do experimento foram realizadas cinco coletas de mudas a serem avaliadas aos 28, 42, 56, 70 e 84 dias após o transplantio. As mudas foram analisadas quanto ao comprimento da parte aérea, número de folhas, diâmetro do coleto, área foliar e massa seca do caule, das folhas, das raízes, da parte aérea, da massa seca total e da relação entre a massa seca da parte aérea e das raízes. As mudas de E. velutina possuem potencial de desenvolvimento de características xeromórficas para o uso conservador de água por meio de diferentes adaptações morfológicas, como desfolha e maior desenvolvimento de raízes. As mudas de E. velutina devem ser produzidas sem restrição hídrica.

US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011.

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Hicks, Lauri A; Bartoces, Monina G; Roberts, Rebecca M; Suda, Katie J; Hunkler, Robert J; Taylor, Thomas H; Schrag, Stephanie J

2015-05-01

Appropriate antibiotic prescribing is an essential strategy to reduce the spread of antibiotic resistance. US prescribing practices have not been thoroughly characterized. We analyzed outpatient antibiotic prescribing data to identify where appropriate antibiotic prescribing interventions could have the most impact. Oral antibiotic prescriptions dispensed during 2011 were extracted from the IMS Health Xponent database. The number of prescriptions and census denominators were used to calculate prescribing rates. Prescription totals were calculated for each provider specialty. Regression modeling was used to examine the association between socioeconomic and population health factors and prescribing rates. Healthcare providers prescribed 262.5 million courses of antibiotics in 2011(842 prescriptions per 1000 persons). Penicillins and macrolides were the most common antibiotic categories prescribed. The most commonly prescribed individual antibiotic agent was azithromycin. Family practitioners prescribed the most antibiotic courses (24%). The prescribing rate was higher in the South census region (931 prescriptions per 1000 persons) than in the West (647 prescriptions per 1000 persons; P 1.0). Efforts to characterize antibiotic prescribing practices should focus on the South census region and family practitioners. Further understanding of the factors leading to high prescribing among key target populations will inform appropriate prescribing interventions. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Extrato aquoso de ramos de Trichilia pallida e o desenvolvimento de Spodoptera frugiperda em genótipos de milho

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Torrecillas Sônia Martins

2001-01-01

Full Text Available Avaliaram-se o desenvolvimento e a sobrevivência da lagarta-do-cartucho, Spodoptera frugiperda (J. E. Smith criada em folhas de dois genótipos de milho (o padrão comercial C 901 e o resistente CMS 23 tratados com extratos aquosos (0,1 e 1% de ramos da planta inseticida Trichilia pallida Swartz (Meliaceae. As variáveis biológicas avaliadas foram peso, duração e viabilidade das fases larval e pupal. Em plantas tratadas com o extrato a 1%, ocorreu mortalidade total das lagartas nos dois genótipos, enquanto que a 0,1% o extrato reduziu a sobrevivência e o peso larval e prolongou o período de desenvolvimento. Lagartas alimentadas com o genótipo CMS 23 apresentaram menor sobrevivência, menor peso e maior período de desenvolvimento do que no genótipo C 901.

Comparison of Prescribed and Measured Dialysate Sodium: A Quality Improvement Project.

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Gul, Ambreen; Miskulin, Dana C; Paine, Susan S; Narsipur, Sriram S; Arbeit, Leonard A; Harford, Antonia M; Weiner, Daniel E; Schrader, Ronald; Horowitz, Bruce L; Zager, Philip G

2016-03-01

There is controversy regarding the optimal dialysate sodium concentration for hemodialysis patients. Dialysate sodium concentrations of 134 to 138 mEq/L may decrease interdialytic weight gain and improve hypertension control, whereas a higher dialysate sodium concentration may offer protection to patients with low serum sodium concentrations and hypotension. We conducted a quality improvement project to explore the hypothesis that prescribed and delivered dialysate sodium concentrations may differ significantly. Cross-sectional quality improvement project. 333 hemodialysis treatments in 4 facilities operated by Dialysis Clinic, Inc. Measure dialysate sodium to assess the relationships of prescribed and measured dialysate sodium concentrations. Magnitude of differences between prescribed and measured dialysate sodium concentrations. Dialysate sodium measured pre- and late dialysis. The least square mean of the difference between prescribed minus measured dialysate sodium concentration was -2.48 (95% CI, -2.87 to -2.10) mEq/L. Clinics with a greater number of different dialysate sodium prescriptions (clinic 1, n=8; clinic 2, n=7) and that mixed dialysate concentrates on site had greater differences between prescribed and measured dialysate sodium concentrations. Overall, 57% of measured dialysate sodium concentrations were within ±2 mEq/L of the prescribed dialysate sodium concentration. Differences were greater at higher prescribed dialysate sodium concentrations. We only studied 4 facilities and dialysate delivery machines from 2 manufacturers. Because clinics using premixed dialysate used the same type of machine, we were unable to independently assess the impact of these factors. Pressures in dialysate delivery loops were not measured. There were significant differences between prescribed and measured dialysate sodium concentrations. This may have beneficial or deleterious effects on clinical outcomes, as well as confound results from studies assessing the

Do final-year medical students have sufficient prescribing competencies? A systematic literature review.

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Brinkman, David J; Tichelaar, Jelle; Graaf, Sanne; Otten, René H J; Richir, Milan C; van Agtmael, Michiel A

2018-04-01

Prescribing errors are an important cause of patient safety incidents and are frequently caused by junior doctors. This might be because the prescribing competence of final-year medical students is poor as a result of inadequate clinical pharmacology and therapeutic (CPT) education. We reviewed the literature to investigate which prescribing competencies medical students should have acquired in order to prescribe safely and effectively, and whether these have been attained by the time they graduate. PubMed, EMBASE and ERIC databases were searched from the earliest dates up to and including January 2017, using the terms 'prescribing', 'competence' and 'medical students' in combination. Articles describing or evaluating essential prescribing competencies of final-year medical students were included. Twenty-five articles describing, and 47 articles evaluating, the prescribing competencies of final-year students were included. Although there seems to be some agreement, we found no clear consensus among CPT teachers on which prescribing competencies medical students should have when they graduate. Studies showed that students had a general lack of preparedness, self-confidence, knowledge and skills, specifically regarding general and antimicrobial prescribing and pharmacovigilance. However, the results should be interpreted with caution, given the heterogeneity and methodological weaknesses of the included studies. There is considerable evidence that final-year students have insufficient competencies to prescribe safely and effectively, although there is a need for a greater consensus among CPT teachers on the required competencies. Changes in undergraduate CPT education are urgently required in order to improve the prescribing of future doctors. © 2018 VU University Medical Centre. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

Importance the limits in development of children specifically

OpenAIRE

Jussara Iensen Pedroso; Carlos Décimo Martins

2013-01-01

O atual trabalho de pesquisa tem como proposta refletir sobre a importância do estabelecimento, por parte de pais e professores, de normas e regras de comportamento no desenvolvimento das crianças, no seu processo educativo e na sua constituição como sujeitos. Discutir sobre limites na formação das crianças, especificamente de crianças especiais, é de extrema importância principalmente no momento em que se procura efetivar a sua inclusão nos ambientes sociais. A partir da análise de dados, po...

Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial.

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Meeker, Daniella; Knight, Tara K; Friedberg, Mark W; Linder, Jeffrey A; Goldstein, Noah J; Fox, Craig R; Rothfeld, Alan; Diaz, Guillermo; Doctor, Jason N

2014-03-01

"Nudges" that influence decision making through subtle cognitive mechanisms have been shown to be highly effective in a wide range of applications, but there have been few experiments to improve clinical practice. To investigate the use of a behavioral "nudge" based on the principle of public commitment in encouraging the judicious use of antibiotics for acute respiratory infections (ARIs). Randomized clinical trial in 5 outpatient primary care clinics. A total of 954 adults had ARI visits during the study timeframe: 449 patients were treated by clinicians randomized to the posted commitment letter (335 in the baseline period, 114 in the intervention period); 505 patients were treated by clinicians randomized to standard practice control (384 baseline, 121 intervention). The intervention consisted of displaying poster-sized commitment letters in examination rooms for 12 weeks. These letters, featuring clinician photographs and signatures, stated their commitment to avoid inappropriate antibiotic prescribing for ARIs. Antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses in baseline and intervention periods, adjusted for patient age, sex, and insurance status. Baseline rates were 43.5% and 42.8% for control and poster, respectively. During the intervention period, inappropriate prescribing rates increased to 52.7% for controls but decreased to 33.7% in the posted commitment letter condition. Controlling for baseline prescribing rates, we found that the posted commitment letter resulted in a 19.7 absolute percentage reduction in inappropriate antibiotic prescribing rate relative to control (P = .02). There was no evidence of diagnostic coding shift, and rates of appropriate antibiotic prescriptions did not diminish over time. Displaying poster-sized commitment letters in examination rooms decreased inappropriate antibiotic prescribing for ARIs. The effect of this simple, low-cost intervention is comparable in magnitude to costlier, more

[Antibiotic prescribing in acute respiratory tract infections in general practice].

Science.gov (United States)

Malo, S; Bjerrum, L; Feja, C; Lallana, M J; Poncel, A; Rabanaque, M J

2015-06-01

Antimicrobial resistance is a worldwide threat to public health. Acute respiratory tract infections are the main reason for antibiotic prescribing in the Spanish paediatric population. The aim of the study was to describe the frequency of antibiotic prescription and their pattern of use in acute respiratory tract infections diagnosed in children in Primary Care in Aragón (Spain). A study was conducted over a 1-year period on children between 0 and 14 years-old, recording all episodes of acute otitis, acute pharyngotonsillitis, non-specific upper respiratory infection, and acute bronchitis. The proportion of episodes within each diagnosis receiving an antibiotic prescription was calculated, and the prescribing pattern was determined. Half (50%) of the children in Aragón were diagnosed with a respiratory tract infection during the study period. Non-specific upper respiratory infection was the most frequent diagnosis. An antibiotic was prescribed in 75% of pharyngotonsillitis episodes, 72% of otitis, 27% of bronchitis, and 16% of non-specific upper respiratory infections. Broad spectrum antibiotics, mainly amoxicillin and amoxicillin-clavulanic, were predominantly prescribed. Antibiotic prescribing in respiratory tract infections in children was generally high, and the choice of antibiotics was probably inappropriate in a high percentage of cases. Therefore an improvement in antibiotic prescribing in children appears to be needed. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Prescribed burning in the South: trends, purpose, and barriers

Science.gov (United States)

Terry K. Haines; Rodney L. Busby; David A. Cleaves

2001-01-01

The results of a survey of fire management officials concerning historical and projected prescribed burning activity in the South are reported. Prescribed burning programs on USDA Forest Service and private and State-owned lands are described in terms of area burned by ownership and State, intended resource benefits, barriers to expanded burning, and optimum burning...

OS MODELOS DE CRESCIMENTO E DE DESENVOLVIMENTO ECONÔMICO E SUA APLICABILIDADE NAS ECONOMIAS REGIONAIS NÃO DESENVOLVIDAS

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Adelmo M. França

2012-01-01

Full Text Available Neste artigo serão apresentadas as definições de crescimento e desenvolvimento econômico e as algumas discussões propostas pelos principais modelos econômicos voltados ao crescimento e desenvolvimento econômicos, questionando o fato deles terem suas origens nas economias desenvolvidas e, portanto, distantes das realidades sociais, políticas e econômicas dos países e das regiões pobres ou em fase de desenvolvimento. As abordagens sobre o tema estarão focadas na realidade econômica brasileira dos anos 1950 até a presente data, explicitando-se as dificuldades e os avanços econômicos realizados no período acima mencionado, considerando as disparidades no crescimento e desenvolvimento regional. Não ficarão fora os possíveis entraves ou externalidades positivas oriundas do cenário econômico internacional, tanto na forma de benefícios para a economia brasileira, quanto na forma de contribuição do Brasil para o mundo não desenvolvido. A presença da economia e da política externa brasileira está cada vez mais evidente e, neste sentido o Brasil vem somando forças para se estabilizar no cenário econômico internacional, bem como contribuindo para a melhoria das econômicas com maiores comprometimentos que o Brasil.

A meta-synthesis study of literature review and systematic review published in nurse prescribing.

Science.gov (United States)

Darvishpour, Azar; Joolaee, Soodabeh; Cheraghi, Mohammad Ali

2014-01-01

Prescribing represents a new aspect of practice for nurses. To make qualitative results more accessible to clinicians, researchers, and policy makers, individuals are urged to synthesize findings from related studies. Therefore this study aimed to aggregate and interpret existing literature review and systematic studies to obtain new insights on nurse prescription. This was a qualitative meta synthesis study using Walsh and Downe process. In order to obtain data all Digital National Library of Medicine's databases, search engines and several related sites were used. Full texts with "review and nurs* prescri* " words in the title or abstract in English language and published without any time limitation were considered. After eliminating duplicate and irrelevant studies, 11 texts were selected. Data analysis was conducted using qualitative content analysis. Multiple codes were compared based on the differences and similarities and divided to the categories and themes. The results from the meta synthesis of the 11 studies revealed 8 themes namely: leading countries in prescribing, views, features, infrastructures, benefits, disadvantages, facilitators and barriers of nursing prescription that are discussed in this article. The results led to a schematic model. Despite the positive view on nurse prescribing, there are still issues such as legal, administrative, weak research and educational deficiencies in academic preparation of nurses that needs more effort in these areas and requires further research.

Suicide risk reduction in youths with attention-deficit/hyperactivity disorder prescribed methylphenidate: A Taiwan nationwide population-based cohort study.

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Liang, Sophie Hsin-Yi; Yang, Yao-Hsu; Kuo, Ting-Yu; Liao, Yin-To; Lin, Tzu-Chin; Lee, Yena; McIntyre, Roger S; Kelsen, Brent A; Wang, Tsu-Nai; Chen, Vincent Chin-Hung

2018-01-01

Attention-deficit/hyperactivity disorder (ADHD) youths have increased suicide risk. Nevertheless, the beneficial effects of methylphenidate (MPH) on suicide attempt have received relatively little attention. To investigate the MPH usage and the risk of suicide attempt among ADHD youths. We identified 84,898 youths less than 18 years old with ADHD diagnosis between 1997 and 2013 from National Health Insurance, and examined whether MPH use affected suicide attempt risk using Cox proportional-hazards models. Among ADHD youths, reduction of suicide risk was found in patients prescribed 90-180days of MPH after adjusting for confounding factors (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.19-0.90) and a greater reduction in those prescribed more than 180days of MPH (HR: 0.28, 95% CI: 0.17-0.48). We observed a 59% suicide attempt risk reduction among ADHD youths prescribed between 90 and 180days and a 72% risk reduction in those prescribed more than 180days of MPH. The protective benefit observed by the group prescribed MPH for longer duration underscores the importance of psychoeducation and compliance enhancement as part of ADHD management. Indication bias is identified as a limitation of this study, and future self-case control study to investigate the association between suicide attempt and ADHD medication is suggested. This nationwide population-based cohort study showed that among ADHD youths, reduction of suicide risk was observed in patients prescribed MPH for duration 90days and longer, underscoring the importance of appropriate ADHD pharmacotherapy and enhancing drug compliance. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Evoking prescribed spike times in stochastic neurons

Science.gov (United States)

Doose, Jens; Lindner, Benjamin

2017-09-01

Single cell stimulation in vivo is a powerful tool to investigate the properties of single neurons and their functionality in neural networks. We present a method to determine a cell-specific stimulus that reliably evokes a prescribed spike train with high temporal precision of action potentials. We test the performance of this stimulus in simulations for two different stochastic neuron models. For a broad range of parameters and a neuron firing with intermediate firing rates (20-40 Hz) the reliability in evoking the prescribed spike train is close to its theoretical maximum that is mainly determined by the level of intrinsic noise.

Supporting biodiversity by prescribed burning in grasslands - A multi-taxa approach.

Science.gov (United States)

Valkó, Orsolya; Deák, Balázs; Magura, Tibor; Török, Péter; Kelemen, András; Tóth, Katalin; Horváth, Roland; Nagy, Dávid D; Debnár, Zsuzsanna; Zsigrai, György; Kapocsi, István; Tóthmérész, Béla

2016-12-01

There are contrasting opinions on the use of prescribed burning management in European grasslands. On the one hand, prescribed burning can be effectively used for the management of open landscapes, controlling dominant species, reducing accumulated litter or decreasing wildfire risk. On the other hand burning can have a detrimental impact on grassland biodiversity by supporting competitor grasses and by threatening several rare and endangered species, especially arthropods. We studied the effects of prescribed burning in alkaline grasslands of high conservation interest. Our aim was to test whether dormant-season prescribed burning can be an alternative conservation measure in these grasslands. We selected six sites in East-Hungary: in three sites, a prescribed fire was applied in November 2011, while three sites remained unburnt. We studied the effects of burning on soil characteristics, plant biomass and on the composition of vegetation and arthropod assemblages (isopods, spiders, ground beetles and rove beetles). Soil pH, organic matter, potassium and phosphorous did not change, but soluble salt content increased significantly in the burnt sites. Prescribed burning had several positive effects from the nature conservation viewpoint. Shannon diversity and the number of flowering shoots were higher, and the cover of the dominant grass Festuca pseudovina was lower in the burnt sites. Graminoid biomass was lower, while total, green and forb biomass were higher in the burnt plots compared to the control. The key finding of our study was that prescribed burning did not decrease the abundance and diversity of arthropod taxa. Species-level analyses showed that out of the most abundant invertebrate species, 10 were not affected, 1 was negatively and 1 was positively affected by burning. Moreover, our results suggest that prescribed burning leaving unburnt patches can be a viable management tool in open landscapes, because it supports plant diversity and does not threaten

O DIREITO AO DESENVOLVIMENTO NACIONAL SUSTENTÁVEL E SUA PROMOÇÃO POR MEIO DA LICITAÇÃO

OpenAIRE

Araujo, Carolline Negreiros

2014-01-01

O direito ao desenvolvimento nacional sustentável tem influenciado a legislação brasileira que vem criando mecanismos para sua concretização. Neste artigo abordamos a importância da observação desse direito fundamental pela administração pública, principalmente quanto aos procedimentos licitatórios, objetivando verificar as maneiras corretas de aplicação e explicando os motivos que levaram a inclusão desta finalidade de promoção do desenvolvimento nacional sustentável. A pesquisa foi realizad...

Transtorno do Desenvolvimento da Coordenação: uma Revisão de Literatura

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Wagner PULZI

2015-09-01

Full Text Available RESUMOO movimento possui relação direta com a aprendizagem e com as relações sociais. Crianças que apresentam dificuldades de movimento podem possuir o transtorno do desenvolvimento da coordenação (TDC. O presente artigo trata-se de uma revisão bibliográfica sobre o assunto e teve por objetivo discutir o que foi publicado sobre o TDC entre os anos de 2002 e 2012, apresentando um panorama quanto ao histórico, prevalência, influências na vida cotidiana, acadêmica e social e possibilidades de intervenção. O termo TDC é usado para se referir às dificuldades nas habilidades motoras e que não é devido deficiências de ordem intelectual, sensorial primária ou neurológica. Esse problema afeta a vida das crianças no seu cotidiano, nas atividades de lazer, na escola e na vida social. Na escola, esse transtorno acarreta em baixo rendimento acadêmico, dificuldades de escrita e compreensão de conceitos matemáticos. Na vida social, pode ocorrer o isolamento e a dificuldade de pertencer a um grupo. Tanto os pais como os professores podem auxiliar no desenvolvimento global e social dessas crianças através de estratégias diferenciadas. Atualmente, destaca-se a necessidade de desenvolvimento de propostas que visem desenvolver e potencializar as habilidades dos escolares com dificuldades motoras.

Opioid Prescribing After Curative-Intent Surgery: A Qualitative Study Using the Theoretical Domains Framework.

Science.gov (United States)

Lee, Jay S; Parashar, Vartika; Miller, Jacquelyn B; Bremmer, Samantha M; Vu, Joceline V; Waljee, Jennifer F; Dossett, Lesly A

2018-07-01

Excessive opioid prescribing is common after curative-intent surgery, but little is known about what factors influence prescribing behaviors among surgeons. To identify targets for intervention, we performed a qualitative study of opioid prescribing after curative-intent surgery using the Theoretical Domains Framework, a well-established implementation science method for identifying factors influencing healthcare provider behavior. Prior to data collection, we constructed a semi-structured interview guide to explore decision making for opioid prescribing. We then conducted interviews with surgical oncology providers at a single comprehensive cancer center. Interviews were recorded, transcribed verbatim, then independently coded by two investigators using the Theoretical Domains Framework to identify theoretical domains relevant to opioid prescribing. Relevant domains were then linked to behavior models to select targeted interventions likely to improve opioid prescribing. Twenty-one subjects were interviewed from November 2016 to May 2017, including attending surgeons, resident surgeons, physician assistants, and nurses. Five theoretical domains emerged as relevant to opioid prescribing: environmental context and resources; social influences; beliefs about consequences; social/professional role and identity; and goals. Using these domains, three interventions were identified as likely to change opioid prescribing behavior: (1) enablement (deploy nurses during preoperative visits to counsel patients on opioid use); (2) environmental restructuring (provide on-screen prompts with normative data on the quantity of opioid prescribed); and (3) education (provide prescribing guidelines). Key determinants of opioid prescribing behavior after curative-intent surgery include environmental and social factors. Interventions targeting these factors are likely to improve opioid prescribing in surgical oncology.

Do final‐year medical students have sufficient prescribing competencies? A systematic literature review

Science.gov (United States)

Tichelaar, Jelle; Graaf, Sanne; Otten, René H. J.; Richir, Milan C.; van Agtmael, Michiel A.

2018-01-01

Aims Prescribing errors are an important cause of patient safety incidents and are frequently caused by junior doctors. This might be because the prescribing competence of final‐year medical students is poor as a result of inadequate clinical pharmacology and therapeutic (CPT) education. We reviewed the literature to investigate which prescribing competencies medical students should have acquired in order to prescribe safely and effectively, and whether these have been attained by the time they graduate. Methods PubMed, EMBASE and ERIC databases were searched from the earliest dates up to and including January 2017, using the terms ‘prescribing’, ‘competence’ and ‘medical students’ in combination. Articles describing or evaluating essential prescribing competencies of final‐year medical students were included. Results Twenty‐five articles describing, and 47 articles evaluating, the prescribing competencies of final‐year students were included. Although there seems to be some agreement, we found no clear consensus among CPT teachers on which prescribing competencies medical students should have when they graduate. Studies showed that students had a general lack of preparedness, self‐confidence, knowledge and skills, specifically regarding general and antimicrobial prescribing and pharmacovigilance. However, the results should be interpreted with caution, given the heterogeneity and methodological weaknesses of the included studies. Conclusions There is considerable evidence that final‐year students have insufficient competencies to prescribe safely and effectively, although there is a need for a greater consensus among CPT teachers on the required competencies. Changes in undergraduate CPT education are urgently required in order to improve the prescribing of future doctors. PMID:29315721

Cinza vegetal na germinação e no desenvolvimento da alface

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Marcelo Alves Terra

2014-01-01

Full Text Available O objetivo deste trabalho foi avaliar o efeito da cinza vegetal na germinação e no desenvolvimento da alface da variedade Lucy Brown, tipo americana. O tipo escolhido foi semeado em bandejas de isopor com cento e vinte oito células. As bandejas continham os seguintes substratos: cinza vegetal, esterco bovino, casca arroz crua, casca de arroz carbonizada, serragem, misturados com solo na proporção de 1:1, além de substrato comercial, solo com adubação de NPK e solo sem adubação. Após o início da germinação, as plântulas foram contadas de três em três dias. Mudas de alface da mesma variedade com três folhas verdadeiras foram transplantadas para caixas de leite com os mesmos substratos. Trinta e três dias após o transplante, a alface foi colhida, as folhas foram contadas, a biomassa verde e a biomassa seca foram determinadas e os caules e as raízes foram contados. O substrato que proporcionou a maior germinação foi a mistura de solo com esterco. Depois, vieram o substrato comercial, o solo com casca de arroz carbonizada, o solo puro, o solo com casca de arroz crua, o solo com NPK, o solo com serragem e o solo com cinza vegetal. Neste último, germinaram apenas de 7,83% das sementes. No momento da colheita, verificou-se, para todos os parâmetros avaliados, com exceção do peso seco da raiz, que o substrato que proporcionou o melhor desenvolvimento foi o solo com esterco bovino, que se diferenciou estatisticamente dos demais substratos avaliados. A cinza vegetal influenciou negativamente tanto na germinação quanto no desenvolvimento das plantas de alface.

The viability of prescribed fire for mitigating the soil degradational impacts of wildfire

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Shakesby, R. A.; Bento, C. P. M.; Ferreira, C. S. S.; Ferreira, A. J. D.; Stoof, C. R.; Urbanek, E.; Walsh, R. P. D.

2012-04-01

Prescribed (controlled) fire has become an important strategy primarily to limit the likelihood of more devastating wildfire. The considerable increase in wildfire activity in recent decades throughout the Mediterranean, and in Portugal in particular, has meant that this strategy has become increasingly popular despite inherent fears of people about fire of any sort. Despite many studies of the impact of wildfire on soil erosion and degradation, relatively little research has assessed impacts of prescribed fire on soil in Portugal or elsewhere in the Mediterranean. As part of the DESIRE research programme, this paper addresses this research gap by investigating hillslope-scale losses of soil, soil organic matter and selected nutrients before and after an experimental fire (representing a 'worst case-scenario' prescribed fire) in a shrub-vegetated catchment in central Portugal. Comparison is provided by post-fire monitoring of a nearby hillslope affected by a wildfire of moderate severity. Hillslope-scale measurements were carried out over c. 3 years using sediment fences with contributing areas of up to c. 0.5 ha. Eroded sediment was periodically removed from the fences both before and after the fire at intervals ranging from a few weeks to several months depending on rainfall characteristics and logistics. Erosion expressed as g/m2 and g/m2/mm of rainfall was determined. Figures for long-term (c. 10 years) erosion under unburnt conditions for this vegetation type were obtained from a small bounded plot and from sediment accumulating in a weir pool draining a sub-catchment within the prescribed-fire catchment. In addition, soil organic matter and selected nutrients, including K2O, P2O5 and Total N, were measured in the eroded sediment and in the pre-burn and post-burn in situ soil. The results indicate that both the wildfire and prescribed fire caused erosion that was orders of magnitude higher than for long-term plot-scale and hillslope-scale erosion recorded

Desenvolvimento da Coordenação Motora Fina: Sugestões Estratégicas

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Berenice Crestana Guardia

2007-06-01

Full Text Available Este artigo tem como objetivo de sugerir atividades para a fase inicial da aprendizagem da escrita, partindo de uma visão geral dos aspectos que o desenvolvimento da coordenção motora fina apresenta na prática pedagógica.

DESENVOLVIMENTO DE MUDAS DE ALFACE EM DIFERENTES SUBSTRATOS E CONCENTRAÇÕES

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Mário Pechara Jaeggi

2017-04-01

Full Text Available Objetivou-se com este trabalho avaliar o desempenho de diferentes substratos e concentrações, no desenvolvimento de cultivares de alface. O experimento foi conduzido em casa de vegetação, localizada no setor de Agroecologia do Instituto Federal do Espírito Santo Campus de Alegre, ES. O delineamento utilizado foi em blocos casualizados disposto em um esquema fatorial 4x3x2, sendo quatro tipos substratos (S1: Plantmax®; S2: composto orgânico; S3: húmus de minhoca; S4: borra de cana-de-açúcar, três concentrações (100%, 75% e 50% e duas cultivares de alface. As variáveis avaliadas foram: massa fresca da parte aérea, massa fresca toal e altura da parte aérea. As mudas foram avaliadas ao 21° dia após semeio. Os resultados demostraram que substratos orgânicos se mostraram eficazes para o desenvolvimento das cultivares de alface, os quais podem ser utilizados em diferentes concentrações em substituição ao substrato comercial.

Taurina no desenvolvimento de embriões bovinos fecundados in vitro

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Camargo L.S.A.

2002-01-01

Full Text Available O objetivo deste trabalho foi avaliar o efeito de diferentes concentrações de taurina no desenvolvimento de embriões bovinos fecundados in vitro em meio de cultivo com diferentes fontes de soro. No experimento 1, zigotos (n=440 fecundados in vitro foram distribuídos aleatoriamente nos tratamentos com 0, 3, 7 ou 14 mM de taurina em meio de cultivo acrescido de 10% de soro fetal bovino (SFB e 3g/l de albumina sérica bovina (BSA. No experimento 2, os zigotos (n=940 foram divididos nos tratamentos com 0, 3 ou 14 mM de taurina em meio acrescido de 10% de SFB ou 3g/l de BSA. No experimento 3, os zigotos (n=191 foram divididos nos tratamentos com 0 ou 3 mM de taurina em meio de cultivo sem fonte de soro, porém adicionado de 3 g/l de álcool polivinil. Nos experimentos 1 e 2 não se observou diferença (P>0,05 na taxa de clivagem, na produção de blastocistos e no número de células entre as concentrações de taurina avaliadas. No experimento 3 encontraram-se maior (P<0,05 taxa de clivagem (68,5% vs. 16,9% e produção de blastocistos (8,3% vs. 0% na presença de taurina. O cultivo de zigotos em meio adicionado de SFB produziu maior (P<0,01 taxa de blastocistos no sétimo (25,6% vs. 6,7% e oitavo (30,8% vs. 13,9% dia pós-fecundação e número de células/blastocistos (104,8± 2,63 vs. 84,7± 3,86 do que no cultivo com BSA, apesar de menor (P<0,01 taxa de clivagem (58,1% vs. 71,3%. Conclui-se que o efeito benéfico da taurina no desenvolvimento embrionário somente é observado na ausência de SFB e BSA. O SFB produz menor taxa de clivagem mas melhora o desenvolvimento embrionário após as primeiras divisões celulares.

An evaluation of the appropriateness and safety of nurse and midwife prescribing in Ireland.

LENUS (Irish Health Repository)

Naughton, Corina

2012-09-19

AIM: To evaluate the clinical appropriateness and safety of nurse and midwife prescribing practice. BACKGROUND: The number of countries introducing nurse and midwife prescribing is increasing; however, concerns over patient safety remain. DESIGN: A multi-site documentation evaluation was conducted using purposeful and random sampling. The sample included 142 patients\\' records and 208 medications prescribed by 25 Registered Nurse Prescribers. METHODS: Data were extracted from patient and prescription records between March-May 2009. Two expert reviewers applied the modified Medication Appropriate Index tool (8 criteria) to each drug. The percentage of appropriate or inappropriate responses for each criterion was reported. Reviewer concordance was measured using the Cohen\\'s kappa statistic (inter-rater reliability). RESULTS: Nurse or midwife prescribers from eight hospitals working in seventeen different areas of practice were included. The reviewers judged that 95-96% of medicines prescribed were indicated and effective for the diagnosed condition. Criteria relating to dosage, directions, drug-drugs or disease-condition interaction, and duplication of therapy were judged appropriate in 87-92% of prescriptions. Duration of therapy received the lowest value at 76%. Overall, reviewers indicated that between 69 (reviewer 2)-80% (reviewer 1) of prescribing decisions met all eight criteria. CONCLUSION: The majority of nurse and midwife prescribing decisions were deemed safe and clinically appropriate. However, risk of inappropriate prescribing with the potential for drug errors was detected. Continuing education and evaluation of prescribing practice, especially related to drug and condition interactions, is required to maximize appropriate and safe prescribing.

A qualitative study to explore influences on general practitioners' decisions to prescribe new drugs.

Science.gov (United States)

Jacoby, Ann; Smith, Monica; Eccles, Martin

2003-02-01

Ensuring appropriate prescribing is an important challenge for the health service, and the need for research that takes account of the reasons behind individual general practitioners' (GPs) prescribing decisions has been highlighted. To explore differences among GPs in their decisions to prescribe new drugs. Qualitative approach, using in-depth semistructured interviews. Northern and Yorkshire Health Authority Region. Participants were identified from a random sample of 520 GPs in a quantitative study of patterns of uptake of eight recently introduced drugs. Purposeful sampling ensured inclusion of GPs prescribing any of the eight drugs and working in a range of practice settings. Fifty-six GPs were interviewed, using a topic guide. Interviews were recorded on audiotape. Transcribed text was methodically coded and data were analysed by constantly comparing emerging themes. Both low and high prescribers shared a view of themselves as conservative in their prescribing behaviour. Low prescribers appeared to conform more strongly to group norms and identified a consensus among practice partners in prescribing and cost-consciousness. Conformism to group norms was represented by a commitment to practice formularies. High prescribers more often expressed themselves to be indifferent to drug costs and a shared practice ethos. A shift in the attitudes of some GPs is required before cost-effectiveness is routinely incorporated in drug prescribing. The promotion of rational prescribing is likely to be more successful if efforts are focused on GPs' appreciation of cost issues and attitudes towards shared decision-making and responsibility.

Educação e desenvolvimento: modos de regulação dos sistemas educacionais

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Marisa Ribeiro Teixeira Duarte

2012-11-01

Na atualidade, o debate em torno do desenvolvimento brasileiro é adjetivado como qualificativo de “social” em diversos documentos. Este artigo, mediante a análisede conteúdo de obras clássicas de Sociologia Educacional no País, estuda como searticulou o binômio “educação e desenvolvimento”. A pesquisa, após sintetizar asproposições sociológicas dos períodos anteriores, analisa três aspectos sobre Educaçãoe Desenvolvimento, presentes no documento final da Conferência Nacional deEducação – CONAE, realizada no Brasil em 2010. Participaram da Conferênciaaproximadamente 5.000 educadores de diferentes regiões do País, sob a coordenaçãodo Ministério da Educação. E seu documento final apresenta proposições para aelaboração da Lei que aprova o Plano Nacional de Educação. O diagnóstico sobreo desenvolvimento do País constante no documento final da CONAE, e as funçõesatribuídas às instituições educacionais e aos modos de planejamento subjacentessão analisados à luz da sociologia das regulações sociais. O estudo conclui expondovertentes analíticas esquecidas no documento da Conferência e orientador do PlanoNacional da Educação.

Buen Vivir Andino: Resistência e/ou alternativa ao modelo hegemônico de desenvolvimento

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Klaus Pereira da Silva

Full Text Available Resumo Este ensaio teórico problematiza a ética do Buen Vivir como forma de resistência e/ou alternativa ao modelo hegemônico de desenvolvimento que tem sido disseminado e implementado por organizações internacionais e corporações. Após a declaração das Nações Unidas sobre os direitos indígenas, em 2007 (MAMANI, 2010, o Buen Vivir alcançou status oficial nas Constituições do Equador e da Bolívia. O Buen Vivir é uma visão de mundo distinta da ordem internacional liberal institucionalizada no pós-II Guerra Mundial; fundamenta-se nas noções de cosmovisão relacional e pluriverso (ESCOBAR, 2011, multiverso (MAMANI, 2010 ou ecosofia andina (ESTERMANN, 2013, enunciados no Sul e subalternizados por mais de cinco séculos de colonialidade. Com base nestas noções, o ensaio enfatiza a importância de repensar, segundo uma abordagem decolonial, o papel desempenhado pelos Estados e organizações governamentais internacionais no que diz respeito ao desenvolvimento local. A análise crítica da literatura sugere a existência de múltiplas visões acerca do desenvolvimento que devem ser debatidas no âmbito de estudos organizacionais.

A survey of the criteria for prescribing in cases of borderline refractive errors

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Einat Shneor

2016-01-01

Conclusions: The prescribing criteria found in this study are broadly comparable with those in previous studies and with published prescribing guidelines. Subtle indications suggest that optometrists may become more conservative in their prescribing criteria with experience.

National ambulatory antibiotic prescribing patterns for pediatric urinary tract infection, 1998-2007.

Science.gov (United States)

Copp, Hillary L; Shapiro, Daniel J; Hersh, Adam L

2011-06-01

The goal of this study was to investigate patterns of ambulatory antibiotic use and to identify factors associated with broad-spectrum antibiotic prescribing for pediatric urinary tract infections (UTIs). We examined antibiotics prescribed for UTIs for children aged younger than 18 years from 1998 to 2007 using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Amoxicillin-clavulanate, quinolones, macrolides, and second- and third-generation cephalosporins were classified as broad-spectrum antibiotics. We evaluated trends in broad-spectrum antibiotic prescribing patterns and performed multivariable logistic regression to identify factors associated with broad-spectrum antibiotic use. Antibiotics were prescribed for 70% of pediatric UTI visits. Trimethoprim-sulfamethoxazole was the most commonly prescribed antibiotic (49% of visits). Broad-spectrum antibiotics were prescribed one third of the time. There was no increase in overall use of broad-spectrum antibiotics (P = .67); however, third-generation cephalosporin use doubled from 12% to 25% (P = .02). Children younger than 2 years old (odds ratio: 6.4 [95% confidence interval: 2.2-18.7, compared with children 13-17 years old]), females (odds ratio: 3.6 [95% confidence interval: 1.6-8.5]), and temperature ≥ 100.4°F (odds ratio: 2.9 [95% confidence interval: 1.0-8.6]) were independent predictors of broad-spectrum antibiotic prescribing. Race, physician specialty, region, and insurance status were not associated with antibiotic selection. Ambulatory care physicians commonly prescribe broad-spectrum antibiotics for the treatment of pediatric UTIs, especially for febrile infants in whom complicated infections are more likely. The doubling in use of third-generation cephalosporins suggests that opportunities exist to promote more judicious antibiotic prescribing because most pediatric UTIs are susceptible to narrower alternatives.

Impact of smoke from prescribed burning: Is it a public health concern?

Science.gov (United States)

Haikerwal, Anjali; Reisen, Fabienne; Sim, Malcolm R; Abramson, Michael J; Meyer, Carl P; Johnston, Fay H; Dennekamp, Martine

2015-05-01

Given the increase in wildfire intensity and frequency worldwide, prescribed burning is becoming a more common and widespread practice. Prescribed burning is a fire management tool used to reduce fuel loads for wildfire suppression purposes and occurs on an annual basis in many parts of the world. Smoke from prescribed burning can have a substantial impact on air quality and the environment. Prescribed burning is a significant source of fine particulate matter (PM2.5 aerodynamic diameterprescribed burning on air quality particularly focussing on PM2.5. We have summarised available case studies from Australia including a recent study we conducted in regional Victoria, Australia during the prescribed burning season in 2013. The studies reported very high short-term (hourly) concentrations of PM2.5 during prescribed burning. Given the increase in PM2.5 concentrations during smoke events, there is a need to understand the influence of prescribed burning smoke exposure on human health. This is important especially since adverse health impacts have been observed during wildfire events when PM2.5 concentrations were similar to those observed during prescribed burning events. Robust research is required to quantify and determine health impacts from prescribed burning smoke exposure and derive evidence based interventions for managing the risk. Given the increase in PM2.5 concentrations during PB smoke events and its impact on the local air quality, the need to understand the influence of PB smoke exposure on human health is important. This knowledge will be important to inform policy and practice of the integrated, consistent, and adaptive approach to the appropriate planning and implementation of public health strategies during PB events. This will also have important implications for land management and public health organizations in developing evidence based objectives to minimize the risk of PB smoke exposure.

Definição do escopo em projetos de desenvolvimento de produtos alimentícios: uma proposta de método

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Noelise Martins Manfio

2015-01-01

Full Text Available A concorrência gerada pela globalização e a busca por produtos que satisfaçam os consumidores faz parte da indústria de alimentos. Para tanto, os projetos de desenvolvimento de produtos são fundamentais para as empresas, uma vez que, em 2012, as indústrias de alimentos geraram produtos ao equivalente a 9,5% do PIB brasileiro e faturaram R$ 431,9 bilhões. O setor alimentício se tornou líder, em valor bruto, entre as indústrias de transformação do Brasil. Contudo, identifica-se significativa quantidade de projetos de desenvolvimento de produtos que falham por razões diversas: a escopo mal definido; b mudanças do escopo durante o projeto; c aumento de custo do projeto; d elevado tempo de projeto. A literatura pertinente a essa temática apresenta alguns modelos de desenvolvimento de produtos alimentícios. No entanto, não foca a definição de escopo, refletindo a informalidade dessa etapa em todo o processo. O objeto de pesquisa desta investigação é o escopo dos projetos de desenvolvimento de produtos para empresas da indústria alimentícia. Complementarmente à ciência tradicional, esta pesquisa não se limita à descrição, à explicação e à predição do fenômeno. A pesquisa avança para a proposição de um artefato que melhor trate do objeto de pesquisa. Por esta razão, para a realização deste trabalho, foi utilizada a Design Science Research como método de pesquisa. Como resultado, se propôs um artefato, especificamente um método para a definição do escopo de projetos de desenvolvimento de produtos alimentícios. O método proposto foi desenvolvido a partir da combinação e do refinamento de alguns passos: a da pesquisa bibliográfica; b da experiência prática; c da pesquisa realizada com especialistas do setor de Pesquisa e Desenvolvimento de empresas da indústria alimentícia. O método e sua relevância para o setor de alimentos foram avaliados por especialistas, confirmando que, para uma defini

Influences on Prescribed Burning Activity and Costs in the National Forest System

Science.gov (United States)

David A. Cleaves; Jorge Martinez; Terry K. Haines

2000-01-01

The results of a survey concerning National Forest System prescribed burning activity and costs from 1985 to 1995 are examined. Ninety-five of one hundred and fourteen national forests responded. Acreage burned and costs for conducting burns are reported for four types of prescribed fires slash reduction; management-ignited fires; prescribed natural fires; and brush,...

Concern about the Expanding Prescription Drug Epidemic: A Survey of Licensed Prescribers and Dispensers.

Science.gov (United States)

Wright, R Eric; Reed, Nia; Carnes, Neal; Kooreman, Harold E

2016-01-01

Prescription drug misuse and abuse has reached epidemic levels in the U.S., and stands as a leading cause of death. As the primary gatekeepers to the medications contributing to this epidemic, it is critical to understand the views of licensed health care professionals. In this study, we examine health care professionals' concern regarding prescription drug abuse in their communities and the impact their concern has had on their prescribing and dispensing practices. An online survey of licensed health care providers. Conducted in Indiana. This study was a state-wide evaluation of Indiana's prescription drug monitoring program. The questionnaire asked respondents how concerned they were about prescription drug abuse in their community. Variation in the level of concern was examined using ordinary least squares regression and information about the respondents' demographic background and clinical experience. In addition, we used logistic regression to examine whether concern was associated with changing prescribing and/or dispensing behavior. The majority of providers indicated they were "moderately" or "extremely concerned" about prescription drug abuse in their communities. The level of concern, however, varied significantly by profession, with pharmacists, physicians, nurse practitioners/physician assistants being more concerned than dentists. Additional analyses indicate that providers with higher levels of concern were those who also reported recently changing their prescribing and/or dispensing behavior. The voluntary nature and geographical focus of the study limits the generalizability of the findings. Concern about prescription drug abuse is generally high across the major health care professions; however, a significant minority of providers, particularly among dentists, expressed little or no concern about the epidemic. Increasing health care providers' general level of concern about prescription drug abuse may be an effective public health tool for

Culturas morais e políticas de desenvolvimento na noruega e na união europeia

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Maria Macedo Barroso

2014-06-01

Full Text Available A partir de um diálogo entre os casos da Noruega e da União Europeia, pretendemos analisar a combinação de diferentes fatores e escalas de processos sociais (individuais, institucionais e de unidades políticas nacionais e supranacionais, estruturantes na formação dos sentidos sociais do desenvolvimento, notadamente das relações entre princípios morais e trocas interessadas, constitutivas das "culturas morais" dos universos analisados. Na perspectiva dos indivíduos, observaremos pela lente do caso da UE as motivações, vocações e histórias de vida dos "profissionais do desenvolvimento", bem como as razões da adesão da opinião pública às ações de cooperação internacional. Na escala institucional, abordaremos, nos dois casos, os modelos político-administrativos utilizados pela burocracia do desenvolvimento, e as lógicas dos diferentes grupos organizados para disputar seus recursos, no caso da Noruega. Na dimensão dos Estados, analisaremos a lógica das políticas nacionais e internacionais sob as quais são negociadas as intervenções de cooperação bilateral e/ou multilaterais tanto na Noruega quanto na UE.

Attitudes of physicians and pharmacists towards International Non-proprietary Name prescribing in Belgium.

Science.gov (United States)

Van Bever, Elien; Elseviers, Monique; Plovie, Marijke; Vandeputte, Lieselot; Van Bortel, Luc; Vander Stichele, Robert

2015-03-01

International Non-proprietary Name (INN) prescribing is the use of the name of the active ingredient(s) instead of the brand name for prescribing. In Belgium, INN prescribing began in 2005 and a major policy change occurred in 2012. The aim was to explore the opinions of Dutch-speaking general practitioners (GPs) and pharmacists. An electronic questionnaire with 39 five-point Likert scale statements and one open question was administered in 2013. Multivariate analysis was performed with multiple linear regression on a sum score for benefit statements and for drawback statements. Answers to the open question were qualitatively analysed. We received 745 valid responses with a representable sample for both subgroups. Participants perceived the motives to introduce INN prescribing as purely economic (to reduce pharmaceutical expenditures for the government and the patient). Participants accepted the concept of INN prescribing, but 88% stressed the importance of guaranteed treatment continuity, especially in older, chronic patients, to prevent patient confusion, medication non-adherence and erroneous drug use. In conclusion, the current way in which INN prescribing is applied in Belgium leads to many concerns among primary health professionals about patient confusion and medication adherence. Slightly adapting the current concept of INN prescribing to these concerns can turn INN prescribing into one of the major policies in Belgium to reduce pharmaceutical expenditures and to stimulate rational drug prescribing. © 2014 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

Democracia e cultura no planejamento do desenvolvimento urbano Democracy and culture in the planning of the urban development

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Aline Virgínia Medeiros Nelson

2012-12-01

Full Text Available A cultura e o regime democrático interferem no planejamento de políticas de desenvolvimento das cidades. Em busca de legitimação das ações públicas para melhoria da qualidade de vida da população, o Estado deve compartilhar a decisão sobre prioridades, mediando interesses dos atores sociais. Para isso, a Constituição Federal condiciona a modernização e a democratização da gestão pública, com abertura de novos espaços de deliberação participativa nas cidades. A partir desses pressupostos e através de uma pesquisa bibliográfica e dedutiva, o presente artigo se propõe a analisar como o Estado pode intervir de forma planejada, a fim de apaziguar conflitos, envolvendo a interseção entre expectativas de desenvolvimento, democracia e cultura, para ao final, concluir que esses elementos estão intrinsecamente relacionados. Isso significa que o desenvolvimento urbano vai além do fenômeno econômico e aqualidade de vida, almejada pela sociedade, exige uma atuação conjunta desta com o Estado.The culture and the democratic regime are elements that interfere in planning policies for development of cities. In search of legitimacy of public actions to improve the quality of life of the population, the state should listen to people about priorities, through the mediation of interest of social actors. For this, the Constitution limits the modernization and democratization of public administration, with the opening of new spaces for participatory deliberation in the cities. Of these assumptions, through a literature search and deductive, This study proposes to analyze how the state can intervene, in a planned manner, in the urban order, to appease conflicts, involving the intersection between expectations of development, democracy and culture, so that, ultimately, to conclude that these elements are closely related, which means that urban development goes beyond economic phenomenon and that the quality of life, desired by society

EFEITO DO ENSACAMENTO NA QUALIDADE DE MAÇÃS EM DIFERENTES ESTÁDIOS DE DESENVOLVIMENTO

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JANAÍNA PEREIRA DOS SANTOS

2015-09-01

Full Text Available RESUMO O objetivo deste trabalho foi avaliar a influência do ensacamento na qualidade de maçãs em diferentes estádios de desenvolvimento. Oestudo foi conduzido em pomar orgânico, na Estação Experimental da Epagri de Caçador-SC, durante as safras de 2009/2010 e 2010/2011. Os genótipos de macieira avaliados foram ‘Royal Gala’, ‘Fuji Suprema’, ‘Catarina’ e a seleção M-11/00. Os frutos foram avaliados nos estádios de desenvolvimento intermediário (metade do ciclo, na colheita (maturação comercial e sete dias após a colheita, e em duas diferentescondições (tratamentos: ensacados e não ensacados. O ensacamento foi realizado após o raleio, com embalagens de tecido não texturizado (TNT de coloração branca, quando os frutos apresentavam em torno de 20 mm de diâmetro. Os fatores físico-químicos avaliados foram: cor de fundo, diâmetro, massa fresca, firmeza da polpa, índice de amido, acidez titulável e sólidos solúveis totais. Verificou-se que o ensacamento não interferiu na cor de fundo dos frutos nem no teor de sólidos solúveis totais. Entretanto, dependendo do genótipo de macieira e do estádio de desenvolvimento, houve alteração no diâmetro, na massa fresca, na firmeza, no índice de amido e na acidez titulável dos frutos. O ensacamento pode proporcionar frutos maiores e mais pesados, podendo também antecipar a maturação, caracterizada pela redução da firmeza da polpa e pelo aumento do índice de amido. Em alguns genótipos e estádios de desenvolvimento, os valores médios de acidez titulável foram inferiores nos frutos ensacados.

Rede social de apoio ao desenvolvimento infantil segundo a equipe de saúde da família

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Ana Paula Dezoti

2013-09-01

Full Text Available O objetivo deste estudo foi identificar as redes sociais de apoio às famílias para a promoção do desenvolvimento infantil na perspectiva da equipe Estratégia Saúde da Família. MÉTODOS: Pesquisa qualitativa descritiva. Foram sujeitos doze profissionais de saúde, sendo três de cada categoria profissional: enfermeiro, médico, auxiliar de enfermagem e agente comunitário de saúde que atuam nas unidades de saúde do estudo. Os dados foram coletados por meio de entrevista semiestruturada e analisados segundo análise categorial temática. RESULTADOS: Os resultados evidenciaram três categorias empíricas: Elementos da rede social de apoio; Funções de apoio às famílias; Dificuldades e lacunas na rede social de apoio às famílias. CONCLUSÃO: Considera-se que as redes sociais têm importante papel na vinculação das famílias, fortalecendo seu potencial para o desenvolvimento infantil saudável. Recomenda-se que os profissionais de saúde articulem ações que possam influenciar esses elementos de maneira que promovam o desenvolvimento infantil adequado.

Toxicity limitation on radioactive liquid waste discharge at OPG Nuclear Stations

International Nuclear Information System (INIS)

Dobson, T.; Lovasic, Z.; Nicolaides, G.

2000-01-01

This paper describes the Municipal and Industrial Strategy for Abatement (MISA) regulation, which came into effect in 1995 in Ontario (Ontario Regulation 215/95 under the Environmental Protection Act). This imposed additional limitations on liquid discharges from power generating stations. The MISA regulation has divided discharges into non-event and event streams, which have to be monitored for the prescribed parameters and for toxicity. Radioactive Waste Management Systems fall into the category of non-event streams. Standard toxicity testing involves monitoring lethality of Daphnia Magna and Rainbow trout in the effluent. The new legislation has imposed a need to address several issues: acute toxicity, complying with the specific limits prescribed by the regulation and, in the long run chronic toxicity

Visual Impacts of Prescribed Burning on Mixed Conifer and Giant Sequoia Forests

Science.gov (United States)

Lin Cotton; Joe R. McBride

1987-01-01

Prescribed burning programs have evolved with little concern for the visual impact of burning and the potential prescribed burning can have in managing the forest scene. Recent criticisms by the public of the prescribed burning program at Sequoia National Park resulted in an outside review of the National Park fire management programs in Sequoia, Kings Canyon, and...

Best available control measures for prescribed burning

International Nuclear Information System (INIS)

Smith, A.M.; Stoneman, C.S.

1992-01-01

Section 190 of the Clean Air Act (CAA) as amended in 1990 requires the US Environmental Protection Agency (EPA) to issue guidance on Best Available Control Measures (BACM) of PM 10 (particulate matter with a nominal aerodynamic diameter less than or equal to 10 micrometers) from urban fugitive dust, residential wood combustion, and prescribed silvicultural and agricultural burning (prescribed burning). The purpose of this guidance is to assist states (especially, but not exclusively, those with PM 10 nonattainment areas which have been classified as serious) in developing a control measure for these three source categories. This guidance is to be issued no later than May 15, 1992 as required under the CAA. The guidance will be issued in the form of a policy guidance generic to all three BACM and in the form of Technical Information Documents (TIDs) for each of the three source categories. The policy guidance will provide the analytical approach for determining BACM and the TID will provide the technical information. The purpose of this paper is to present some insight from the forthcoming TID on what BACM might entail for prescribed burning in a serious PM 10 nonattainment area

Avaliação do desenvolvimento mental e psicomotor de crianças de creche com carências nutricionais

OpenAIRE

Patricia de Souza Almeida

2004-01-01

O desenvolvimento infantil tem sido considerado como um processo, que envolve modificabilidade, transformação e interação com o ambiente social. A trajetória desse desenvolvimento, mesmo antes do nascimento, pode ser exposta a múltiplos e contínuos eventos adversos, os fatores de risco, que podem e, normalmente, ocorrem em conjunto, potencializando a gravidade das suas conseqüências. Entre os fatores de risco mais estudados, estão as carências nutricionais, enfoque do presente estudo, cujos ...

Prescribing Habits for Androgenic Alopecia Among Dermatologists in Spain in 2017: A Cross-Sectional Study.

Science.gov (United States)

Pindado-Ortega, C; Saceda-Corralo, D; Buendía-Castaño, D; Fernández-González, P; Moreno-Arrones, Ó M; Fonda-Pascual, P; Alegre-Sánchez, A; Rodrigues-Barata, A R; Vañó-Galván, S

2018-04-12

Topical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA). Descriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain. The responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%). A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy. The most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA. Copyright © 2018 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

Autismo e doenças invasivas de desenvolvimento Autism and pervasive developmental disorders

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Carlos A. Gadia

2004-04-01

Full Text Available OBJETIVO: Revisar os aspectos neurobiológicos do autismo e das doenças invasivas de desenvolvimento. Oferecer ao pediatra informações atualizadas sobre diagnóstico e tratamento. FONTES DOS DADOS: Revisão bibliográfica, abordando o tema por meio do sistema MEDLINE e procura direta. SÍNTESE DOS DADOS: Conforme dados da literatura, o autismo é a terceira mais comum desordem no desenvolvimento, ocorrendo em 40 a 130 casos por 100.000. O diagnóstico é clínico, baseado nos critérios do DSM-IV. Os exames de neuroimagem e neurofetologia e os estudos genéticos contribuem para o melhor entendimento da neurobiologia do autismo. CONCLUSÃO: O pediatra é o primeiro médico a entrar em contato com o paciente autista e deve estar apto para reconhecer os desvios do desenvolvimento e orientar a investigação e o tratamento multidisciplinar.OBJECTIVE: To review the current knowledge on neurobiological aspects of autism and pervasive developmental disorders, as well as to provide pediatricians with up to date information on diagnosis and treatment of autism. SOURCES OF DATA: Review of MEDLINE and Internet. SUMMARY OF THE FINDINGS: Autism is the 3rd developmental disorder, with an incidence of 40 to 130/100,000 individuals. Diagnosis is based on clinical findings, following DSM IV criteria. Neuroimaging, investigation of fetal neurological status, and genetic investigation contribute towards a better understanding of the neurobiology of autism. CONCLUSION: Pediatricians are the first health professional to come in contact with patients with autism. Thus, they should be able to diagnose and to coordinate the multidisciplinary treatment of these patients.

Figura ambígua e dislexia do desenvolvimento Ambiguous figure and developmental dyslexia

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Lílian Braga Alonso

2008-04-01

Full Text Available OBJETIVO: Avaliar o processamento visual de figuras ambíguas em indivíduos disléxicos e compará-lo a um grupo controle leitor normal. MÉTODOS: Survey comparativo onde foram selecionados aleatoriamente 39 escolares cursando entre a primeira e a quarta série do ensino fundamental. Deste total, 26 não apresentavam dificuldade de leitura ou mau rendimento escolar e constituíram o grupo controle. As outras 13 crianças (grupo de estudo eram portadoras de Dislexia do desenvolvimento. Foram apresentadas, pela ordem, uma figura de Boring, uma figura com vasos de Rubin e uma figura pato/coelho de Jastrow. RESULTADOS: Os resultados obtidos mostram que as crianças com diagnóstico de Dislexia do desenvolvimento perceberam número menor de figuras em relação às do grupo controle. CONCLUSÃO: O exame do processamento visual de crianças com Dislexia do desenvolvimento para figuras ambíguas é alterado quando comparado ao de crianças leitoras normais.OBJECTIVE: Evaluate the visual response of children with developmental dyslexia when ambiguous figure was presented in comparison with normal readers children. METHODS: 39 children from basic school was randomly chosen. 26 were normal readers. 13 were diagnosed developmental dyslexia.Were presented the Boring figure, Rubin vessels figure and Jastrow figure. RESULTS: Participants in the clinical group with dyslexia performed marginally less well than those in the control group. CONCLUSION: The visual response of children with developmental dyslexia when ambiguous figure was presented is less well in comparison with normal readers children.

Proton pump inhibitors: potential cost reductions by applying prescribing guidelines.

LENUS (Irish Health Repository)

Cahir, Caitriona

2012-01-01

There are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care. This study aims to establish potential cost savings in a community drug scheme for a one year period according to published clinical and cost-effective guidelines for PPI prescribing.

Seed bank response to prescribed fire in the central Appalachians.

Science.gov (United States)

Thomas M. Schuler; Melissa Thomas Van-Gundy; Mary B. Adams; W. Mark. Ford

2010-01-01

Pre- and post-treatment seed-bank characteristics of woody species were compared after two prescribed fires in a mesic mixed-oak forest in the central Appalachians. Nineteen woody species were identified from soil samples. Mean species richness declined but evenness did not after prescribed burning. The...

O jogo e o desenvolvimento infantil na teoria da atividade e no pensamento educacional de Friedrich Froebel

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Alessandra Arce

Full Text Available Este artigo apresenta um estudo teórico comparativo da pedagogia desenvolvida por Friedrich Froebel e da teoria da atividade (Leontiev, Elkonin e Vigotski no que diz respeito ao jogo e ao desenvolvimento infantil. Ainda que essas duas abordagens considerem o jogo uma atividade muito importante no desenvolvimento da criança, elas diferem em sua visão do que seja o significado do jogo no contexto do processo de formação do indivíduo. Essa divergência é uma conseqüência de suas opostas concepções acerca da relação entre a natureza humana e a história.

O jogo e o desenvolvimento infantil na teoria da atividade e no pensamento educacional de Friedrich Froebel

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Arce Alessandra

2004-01-01

Full Text Available Este artigo apresenta um estudo teórico comparativo da pedagogia desenvolvida por Friedrich Froebel e da teoria da atividade (Leontiev, Elkonin e Vigotski no que diz respeito ao jogo e ao desenvolvimento infantil. Ainda que essas duas abordagens considerem o jogo uma atividade muito importante no desenvolvimento da criança, elas diferem em sua visão do que seja o significado do jogo no contexto do processo de formação do indivíduo. Essa divergência é uma conseqüência de suas opostas concepções acerca da relação entre a natureza humana e a história.

A Computer Prescribing Order Entry-Clinical Decision Support system designed for neonatal care: results of the 'preselected prescription' concept at the bedside.

Science.gov (United States)

Gouyon, B; Iacobelli, S; Saliba, E; Quantin, C; Pignolet, A; Jacqz-Aigrain, E; Gouyon, J B

2017-02-01

The neonatal intensive care units (NICUs) are at the highest risk of drug dose error of all hospital wards. NICUs also have the most complicated prescription modalities. The computerization of the prescription process is currently recommended to decrease the risk of preventable adverse drug effects (pADEs) in NICUs. However, Computer Prescribing Order Entry-Clinical Decision Support (C.P.O.E./C.D.S.) systems have been poorly studied in NICUs, and their technical compatibility with neonatal specificities has been limited. We set up a performance study of the preselected prescription of drugs for neonates, which limited the role of the prescriber to choosing the drugs and their indications. A single 29 bed neonatal ward used this neonatal C.P.O.E./C.D.S. system for all prescriptions of all hospitalized newborns over an 18-month period. The preselected prescription of drugs was based on the indication, gestational age, body weight and post-natal age. The therapeutic protocols were provided by a formulary reference (330 drugs) that had been specifically designed for newborns. The preselected prescription also gave complete information about preparation and administration of drugs by nurses. The prescriber was allowed to modify the preselected prescription but alarms provided warning when the prescription was outside the recommended range. The main clinical characteristics and all items of each line of prescription were stored in a data warehouse, thus enabling this study to take place. Seven hundred and sixty successive newborns (from 24 to 42 weeks' gestation) were prescribed 52 392 lines of prescription corresponding to 65 drugs; About 30·4% of neonates had at least one out of licensed prescription; A prescription out of the recommended range for daily dose was recorded for 1·0% of all drug prescriptions. WHAT IS NEW?: The C.P.O.E./C.D.S. systems can currently provide a complete preselected prescription in NICUs according to dose rules, which are specific to