No abstract

OBJECTIVE:To evaluate user satisfaction with psychosocial healthcare services. METHODS:Qualitative and quantitative study conducted in psychosocial healthcare services in the states of Paraná, Santa Catarina and Rio Grande do Sul, Southern Brazil, in 2006. The study combined quantitative and qualitative methods. Quantitative epidemiological data from a cross-sectional study including 1,162 users of 30 psychosocial healthcare services was used. The instrument used to evaluate users' satisfaction was the Brazilian version of the WHO Users' Satisfaction Scale (SATIS-BR), a 1 to 5-point scale. Qualitative data was collected from fi ve case studies using a fourth generation approach. Information was obtained from fi eld observations and interviews (between ten and 13 users in each fi eld, totaling 57 users) and presented to users in validation and negotiation workshops. RESULTS:The SATIS-BR scale showed that users positively evaluated all items, overall mean 4.4 (SD=0.4). Communication and relationship with psychosocial healthcare services staff had mean 4.5 (SD=0.5), and access to information through staff had mean 4.8. Satisfaction with care service was the lowest, mean 4.1, and general service infrastructure had mean 3.9. The qualitative study revealed that, according to users, the quality of treatment provided was good and the outcome was satisfactory. Their new status, better access to services, ending of their physical and social isolation, response to their demands and helping them reorganize their lives -all contributed to users' satisfaction. CONCLUSIONS:The complementary results of both study approaches showed that users are satisfi ed with care provided at the psychosocial healthcare services studied.

BackgroundAlthough decades have focused on unraveling its etiology, necrotizing enterocolitis (NEC) remains a chief threat to the health of premature infants. Both modifiable and non-modifiable risk factors contribute to varying rates of disease across neonatal intensive care units (NICUs).PurposeThe purpose of this paper is to present a scoping review with two new meta-analyses, clinical recommendations, and implementation strategies to prevent and foster timely recognition of NEC.MethodsUsing the Translating Research into Practice (TRIP) framework, we conducted a stakeholder-engaged scoping review to classify strength of evidence and form implementation recommendations using GRADE criteria across subgroup areas: 1) promoting human milk, 2) feeding protocols and transfusion, 3) timely recognition strategies, and 4) medication stewardship. Sub-groups answered 5 key questions, reviewed 11 position statements and 71 research reports. Meta-analyses with random effects were conducted on effects of standardized feeding protocols and donor human milk derived fortifiers on NEC.ResultsQuality of evidence ranged from very low (timely recognition) to moderate (feeding protocols, prioritize human milk, limiting antibiotics and antacids). Prioritizing human milk, feeding protocols and avoiding antacids were strongly recommended. Weak recommendations (i.e. “probably do it”) for limiting antibiotics and use of a standard timely recognition approach are presented. Meta-analysis of data from infants weighing <1250 g fed donor human milk based fortifier had reduced odds of NEC compared to those fed cow’s milk based fortifier (OR = 0.36, 95% CI 0.13, 1.00; p = 0.05; 4 studies, N = 1164). Use of standardized feeding protocols for infants <1500 g reduced odds of NEC by 67% (OR = 0.33, 95% CI 0.17, 0.65, p = 0.001; 9 studies; N = 4755 infants). Parents recommended that NEC information be shared early in the NICU stay, when feedings were adjusted, or feeding intolerance occurred via print and video materials to supplement verbal instruction.DiscussionEvidence for NEC prevention is of sufficient quality to implement. Implementation that addresses system-level interventions that engage the whole team, including parents, will yield the best impact to prevent NEC and foster its timely recognition.

Avaliação de serviços em saúde mental no contexto da reforma psiquiátricaTexto Contexto Enferm 2004 Out-Dez; 13(4):593-8.

Resumo Este artigo apresenta resultados parciais de uma pesquisa avaliativa desenvolvida em um

Este artigo relata o percurso teórico-metodológico da avaliação dos Centros de Atenção Psicossocial da região sul do Brasil, desenvolvida a partir da Avaliação de Quarta Geração. A coleta de dados foi realizada por meio da observação e de entrevistas com usuários, familiares e equipe; e a primeira etapa de análise ocorreu concomitante à coleta, permitindo que os resultados fossem apresentados ao final da mesma aos sujeitos do estudo em oficinas de negociação. Na segunda etapa, foram realizadas oficinas com os pesquisadores, visando construir um processo coletivo de análise de dados. Como contribuições da Avaliação de Quarta Geração, destacamos o seu caráter participativo e a sua dimensão formativa, possibilitando aos grupos de interesse uma capacidade de análise e de intervenção mais qualificada para a melhoria do serviço. Como limite, destacamos o grande volume de dados obtidos no processo e a necessidade de priorização de questões mediante a negociação com os grupos de interesse.

This qualitative study, using the fourth-generation evaluation, aimed to evaluate the care delivered to drug users in the context of a mental health care network. It was developed in a Family Health Strategy unit in Porto Alegre-RS. Data were collected between September 2010 and March 2011, by means of interviews and field observations. Study participants were 19 Family Health Strategy professionals. The results revealed (dis)connections of the lack of strategies aimed at the care of drug users. This study may lead to the development of devices aimed at a real transformation in health practices and the consolidation of a health care network that considers individuals in their social context.

Risk for neonatal necrotizing enterocolitis (NEC) is complex, reflecting its multi-factorial pathogenesis. To improve risk awareness and facilitate communication among neonatal caregivers especially nurses, two tools were developed. GutCheckNEC was derived and validated as part of a formal research study over three phases including evidence synthesis, expert consensus building and statistical modeling. The Wetzel/Krisman tool, eNEC™ was developed and tested as part of a quality improvement (QI) initiative in a single clinical setting using evidence synthesis, review by internal expert clinicians and implementation and evaluation of its use by direct line neonatal staff. Refinement of both tools is underway to evaluate their effect on clinical decision making, early identification of NEC and surgical NEC. Clinicians can take an active role to reduce NEC in their units by focusing on modifiable risk factors such as adoption of standardized feeding protocols, preferential feeding of human milk, antibiotic and histamine blocker stewardship. Feeding during transfusion remains controversial but judicious use of transfusions, adoption of transfusion guidelines and withholding feeding during transfusion are feasible measures with potential benefit to prevent NEC and little risk.