In this paper, we make explicit the changing configurations of power relations that currently characterize the Brazilian Emergency Care System (SAMU) team in Belo Horizonte, Brazil. The SAMU is a recent innovation in Brazilian healthcare service delivery. A qualitative case study methodology was used to explore SAMU's current organizational arrangements, specifically the power relations that have developed and that demonstrate internal team struggles over space and defense of particular occupational interests. The argument advanced in this paper is that these professionals are developing their work in conditions of exposure, that is, they are always being observed by someone, and that such observational exposure provides the conditions whereby everyday emergency care practices are enacted such that practice is shaped by, as well as shapes, particular, yet recognizable power relationships. Data were collected through the observation of the SAMU's work processes and through semi-structured interviews. Research materials were analyzed using discourse analysis. In the emergency care process of work, visibility is actually embedded in the disciplinary context and can thus be analyzed as a technique applied to produce disciplined individuals through the simple mechanisms elaborated by Foucault such as hierarchical surveillance, normalizing judgment, and the examination.
The study describes adherence to completion of the safe surgery checklist and its respective items by health professionals in a public hospital's surgical center. This was a retrospective document study covering the period from 2010 to 2015. The results show that 58.5% of the checklists were completed out of a total of 24,421 surgeries performed. Checklist adherence was only higher on weekdays in the first year of the study, even though there was a specific professional designated to complete it. There were differences in completion between the surgical times, and in times 1 and 2, there were items that were never used, such as members of the surgical team, patient identification, and place of the surgery. No important changes were observed in adherence to completion of the safe surgery checklist during the study period.
The aim of this study was to investigate the role and influence of nursing in the hospital accreditation process. It is a qualitative study, conducted in a private hospital of Belo Horizonte.The study subjects were nine nurses and 15 nursing technicians. Data collection was through semi-structured interviews, which were subjected to content analysis. The results showed that the role of the nursing team in the accreditation involves care, administrative, educational and research issues. The study subjects presented different perceptions regarding the influence of the accreditation process in their work. The positive aspects of personal growth and valorization of the curriculum were highlighted as well as negative aspects such as stress and little professional valorization. Therefore, it is necessary that the professionals understand the logic of the process and act with a view to the interdisciplinarity and overcoming the fragmentation of care, thus achieving integral healthcare and the quality of care desired.Descriptors: Nursing; Quality of Health Care; Accreditation. La enfermería en hospital en proceso de acreditación: su papel y las consecuencias en el trabajo diarioEste estudio investigó el papel y la influencia de la enfermería en el proceso de acreditación de hospitales. Se trata de un estudio cualitativo realizado en un hospital en Belo Horizonte.Los sujetos del estudio fueron 09 enfermeras y 15 técnicos de enfermería. Los datos fueron recolectados a través de entrevistas semiestructuradas, las que fueron sometidas a análisis de contenido. Los resultados mostraron que la actuación de la enfermería en el proceso de acreditación implica cuestiones relacionadas con la atención, administración, educación e investigación. Los profesionales tenían percepciones diferentes acerca de la influencia del proceso de acreditación en su trabajo. Se destacaron aspectos positivos como el crecimiento personal y el desarrollo del currículo; los negativos fueron estrés y poco desarrollo profesional. Por lo anterior es necesario que los profesionales entiendan la lógica del proceso y actúen con una finalidad interdisciplinaria superando la fragmentación en el cuidado, logrando así la atención integral y la calidad de la atención.Descriptores: Enfermería; Calidad de la Atención de Salud; Acreditación.
The work of Mobile Emergency Medical Service (SAMU) involves the participation of several professionals that meet the demands of different levels of complexity in a huge geographic territory, with planning different of services with exclusively fixed structures. The aim of this study was to analyze the configuration of practices of power in the daily work of professionals of the SAMU. It was a qualitative case study which had been set in the SAMU of Belo Horizonte, Minas Gerais, Brazil. The sample was composed by 31 workers and data were collected using semi-structured interview and than submitted to discourse analysis. In the context of struggles and power relations in SAMU, stands out 'the power of zero vacancy' and the 'uniform bodies and images of power in the SAMU'. It was possible to observe that power in SAMU is present as social practice, with its centrality moving according to lived situations and to interests in question.
This study aimed to investigate the associations of XPC c.2815A>C, XPD c.934G>A and c.2251A>C, XPF c.2505T>C and ERCC1 c.354C>T single nucleotide polymorphisms (SNPs) of nucleotide excision repair pathway in outcome of head and neck squamous cell carcinoma (HNSCC) patients treated with cisplatin (CDDP) chemoradiation. Patients with XPC c.2815AC or CC and XPD c.934GA or AA genotypes had 0.20 and 0.38 less chances of presenting moderate/severe ototoxicity and nausea, respectively. Patients with XPD c.934AA and c.2251AC or CC genotypes had 8.64, 12.29 and 3.55 more chances of achieving complete response (CR), consistent ototoxicity and nephrotoxicity, respectively. AA haplotype of XPD and ACT haplotype of XPD and ERCC1 SNPs were associated with 9.30 and 3.41 more chances of achieving CR and consistent nephrotoxicity, respectively. At 24 months of follow-up, patients with XPD c.934AA genotype presented lower progression-free survival and overall survival in Kaplan-Meier estimates, and differences between groups remained the same in univariate Cox analysis. Patients with XPD c.934AA genotype had 2.13 and 2.04 more risks of presenting tumor progression and death than others in multivariate Cox analysis. Our data present preliminary evidence that XPC c.2815A>C, XPD c.934G>A and c.2251A>C, and ERCC1 c.354C>T SNPs alter outcome of HNSCC patients treated with CDDP chemoradiation.
RESUMO: Elementos da sociedade atual evidenciam a impossibilidade se compreender o direito que está em curso diante da crise do direito estatal se se insiste em manter o constitucionalismo sob as vestes do direito estatal. Instituições sociais públicas e privadas, corporações transnacionais, agrupamentos financeiros, ONGs têm promovido influências na prática do direito sem precedentes na história. Para lidar com a multiplicidade de constituições civis, proponho o constitucionalismo societário transnacional. Palavras-chave: Teoria dos sistema. Constitutionalismo social. Sistema de poder mundial. Regulação. Risco. ABSTRACT: Elements of actual society show that it is impossible to understand the law that is underway in the face of the crisis of the rule of law one insists on maintaining constitutionalism under the guise of state law. Public and private social institutions, transnational corporations, financial groups, NGOs have promoted influences on the practice of law unprecedented in history. In order to deal with the multiplicity of civil constitutions, we propose transnational corporate constitutionalism.
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