RESUMEN Objetivo: Describir el proceso de implantación de las mejores prácticas para la asistencia a la lactancia materna en recién nacidos prematuros y de bajo peso al nacer. Método: Investigación participativa que utilizó la metodología de implementación de evidencia del JBI, realizado en un hospital universitario del sudeste de Brasil, con la participación de un equipo multidisciplinario y gestores. Etapas: Diagnóstico situacional, auditoría de base y retroalimentación, desarrollo de protocolo, capacitación, implementación y seguimiento. Resultados: Se definieron siete criterios de auditoría. En la auditoría de base se cumplieron tres criterios y se enumeraron once barreras por resolver. Las estrategias implementadas fueron el desarrollo de protocolo y la capacitación multidisciplinaria e intersectorial. Luego de la capacitación se logró el cumplimiento de los siete criterios auditados en la primera auditoría de seguimiento y de cinco en la segunda, destacando el incremento en el cumplimiento luego de implementar las estrategias trazadas. Conclusión: El proyecto logró el objetivo de mejorar la práctica basada en evidencia y permitió la implementación del primer protocolo de lactancia materna de la institución, pero destaca la necesidad de mantener la capacitación para la adherencia y la inculturación de nuevas prácticas. Objetivo nacer Método JBI Brasil gestores Etapas situacional retroalimentación Resultados resolver intersectorial segunda trazadas Conclusión institución

RESUMO Objetivo: Descrever o processo de implantação das melhores práticas para assistência à amamentação de recém-nascido prematuro e de baixo peso. Método: Pesquisa participativa que utilizou a metodologia de implementação de evidências do JBI, realizada em hospital universitário no sudeste do Brasil, com participação de equipe multiprofissional e gestores. Etapas: diagnóstico situacional, auditoria de base e feedback, elaboração de protocolo, treinamentos, implementação e monitoramento. Resultados: Foram definidos sete critérios de auditoria. Na auditoria de base, três critérios se mostraram conformes, sendo elencadas onze barreiras para serem solucionadas. As estratégias realizadas foram elaboração de protocolo e treinamentos multidisciplinares e intersetoriais. Após as capacitações obteve-se conformidade dos sete critérios auditados na primeira auditoria de seguimento e de cinco na segunda, enfatizando o aumento da conformidade após concretização das estratégias traçadas. Conclusão: O projeto alcançou o objetivo de melhorar a prática baseada em evidências, e possibilitou a implementação do primeiro protocolo de amamentação da instituição, porém evidencia a necessidade de manutenção dos treinamentos para adesão e enculturação das novas práticas. Objetivo recémnascido recém nascido peso Método JBI Brasil gestores Etapas situacional feedback monitoramento Resultados conformes solucionadas intersetoriais obtevese obteve segunda traçadas Conclusão instituição

ABSTRACT Objective: To describe the process of best practices implementation for breastfeeding assistance for preterm and low birth weight infants. Method: Participatory research that used the evidence implementation methodology of the JBI, held at a university hospital in southeastern Brazil, with the participation of a multidisciplinary team and managers. Stages: Situational diagnosis, baseline audit and feedback, protocol development, training, implementation, and monitoring. Results: Seven audit criteria were defined. In the baseline audit, three criteria were met, with eleven barriers to be resolved being listed. The strategies carried out were protocol development and multidisciplinary and intersectoral training. After the training, compliance was achieved with the seven criteria audited in the first follow-up audit and five in the second, emphasizing the increase in compliance after the implementation of the outlined strategies. Conclusion: The project achieved the objective of improving evidence-based practice, and allowed the implementation of the institution's first breastfeeding protocol. However, it shows the need to maintain training for adherence and enculturation of new practices. Objective infants Method JBI Brazil managers Stages diagnosis feedback monitoring Results defined met listed followup follow up second Conclusion evidencebased based practice institutions institution s However

Abstract This study aimed to analyze the association between early alcohol use in adolescence and associated factors: sociodemographic, involvement in bullying, risk behaviors at school, and social-emotional skills. It was carried out with 528 adolescents from full-time public high schools. Instruments: sociodemographic questionnaire, AUDIT, Victimization Scale among Students, Scale of Authorship of Student Violence, Risk Behavior Scale, and SENNA. In the final model, the variables with a significant association with early alcohol use by adolescents were: not having a religion (PR = 1.28, 95% CI [1.02, 1.60]), parental alcohol consumption (PR = 1.55, 95% CI [1.22, 1.97]), bullying (PR = 1.51, 95% CI [1.14, 1.98]), smoking at school (PR = 1.74, 95% CI [1.36, 2.24]), high engagement with others (PR = 2.59, 95% CI [1.40, 4.79]), and low emotional resilience (PR = 2.16, 95% CI [1.16, 4.03]), all indicating risk. factors socialemotional social skills 52 fulltime full time schools Instruments questionnaire AUDIT Students Violence SENNA model were PR 128 1 28 1.28 95 1.02, 102 02 [1.02 1.60, 160 1.60 , 60 1.60]) 155 55 1.55 1.22, 122 22 [1.22 1.97, 197 1.97 97 1.97]) 151 51 1.51 1.14, 114 14 [1.14 1.98, 198 1.98 98 1.98]) 174 74 1.74 1.36, 136 36 [1.36 2.24, 224 2.24 2 24 2.24]) 259 59 2.59 1.40, 140 40 [1.40 4.79, 479 4.79 4 79 4.79]) 216 16 2.16 1.16, 116 [1.16 4.03, 403 4.03 03 4.03]) 5 12 1.2 9 1.02 10 0 [1.0 1.6 6 1.60] 15 1.5 1.22 [1.2 19 1.9 1.97] 1.14 11 [1.1 1.98] 17 7 1.7 1.36 13 3 [1.3 2.2 2.24] 25 2.5 1.40 [1.4 47 4.7 4.79] 21 2.1 1.16 4.0 4.03] 1. 1.0 [1. 1.1 1.3 2. 1.4 4. [1 [

Resumo Este estudo objetivou analisar a associação entre o uso precoce de álcool na adolescência e fatores associados: sociodemográficos, envolvimento em bullying, comportamentos de risco na escola e competências socioemocionais. Foi realizado com 528 adolescentes de escolas públicas de Ensino Médio de tempo integral. Instrumentos: questionário sociodemográfico, AUDIT, Escala de Vitimização entre Alunos, Escala de Autoria de Violência a Alunos, Escala de Comportamentos de Risco e o SENNA. No modelo final, as variáveis com associação significativa foram: não ter uma religião (RP = 1,28; IC 95% [1,02; 1,60]), consumo de álcool dos pais (RP = 1,55; IC 95% [1,22; 1,97]), autoria de bullying (RP = 1,51; IC 95% [1,14; 1,98]), fumar na escola (RP = 1,74; IC 95% [1,36; 2,24]), alto engajamento com outros (RP = 2,59; IC 95% [1,40; 4,79]) e baixa resiliência emocional (RP = 2,16; IC 95% [1,16; 4,03]), todas indicando risco. associados sociodemográficos socioemocionais 52 integral Instrumentos sociodemográfico AUDIT Alunos SENNA final foram RP 1,28 128 1 28 95 1,02 102 02 [1,02 1,60, 160 1,60 , 60 1,60]) 1,55 155 55 1,22 122 22 [1,22 1,97, 197 1,97 97 1,97]) 1,51 151 51 1,14 114 14 [1,14 1,98, 198 1,98 98 1,98]) 1,74 174 74 1,36 136 36 [1,36 2,24, 224 2,24 2 24 2,24]) 2,59 259 59 1,40 140 40 [1,40 4,79 479 4 79 4,79] 2,16 216 16 1,16 116 [1,16 4,03, 403 4,03 03 4,03]) 5 1,2 12 9 1,0 10 0 [1,0 1,6 6 1,60] 1,5 15 [1,2 19 1,9 1,97] 1,1 11 [1,1 1,98] 1,7 17 7 1,3 13 3 [1,3 2,2 2,24] 2,5 25 1,4 [1,4 4,7 47 2,1 21 4,0 4,03] 1, [1, 2, 4, [1 [

ABSTRACT Introduction: The harvesting of musculoskeletal tissues is essential to ensure the supply of biological products of human origin with safety and clinical efficacy. The harvesting stage must undergo a validation process to guarantee the quality of the tissues. Objectives: This article describes the experience of a public human multi-tissue bank (HMTB) in validating the harvesting of musculoskeletal tissue (femoral head) from a living donor. Methods: This involves evaluating and adapting a harvesting protocol to promote excellence in the quality of tissues distributed for therapeutic and research purposes. To this end, a technical visit was carried out at another tissue bank, and meetings were held with the orthopedic service team to present and discuss the process flow. Donor screening was done by applying forms evaluating the selection and exclusion criteria. After acceptance, through the consent form, the donor’s serological tests were requested and collected. The harvesting kit, control of the temperature thermal transport box, and collecting microbiological material from the piece at the time of removal were validated. The validated harvested tissue underwent macroscopic, radiological, and microbiological evaluations to consider the process valid. The forms and other documents in the medical record were audited by the institution’s health quality and safety center. Process mapping was also carried out, targeting risks and opportunities for improvement. Results: The harvesting protocol was validated as foreseen in the action plan. The harvesting technique was performed sterilely in the operating room. Microbiological and serological analyses showed negative results, and the tissue was considered macroscopically viable. After the audit, the documentation was deemed adequate to comply with current legislation (Resolução da Diretoria Colegiada – RDC Nº 707, of July 1, 2022), and the mapping of processes guaranteed the security of harvesting and provided opportunities for improvement. Conclusion: A protocol for capturing musculoskeletal tissues in the reference service is presented, with the validation process being replicable through a fundamental tool to ensure harmlessness and safety in tissue harvesting. Introduction efficacy Objectives multitissue multi HMTB (HMTB femoral head donor Methods purposes end flow criteria acceptance form donors s collected kit box macroscopic radiological valid institutions institution center improvement Results plan room results viable audit Resolução 707 1 2022, 2022 , 2022) Conclusion presented 70 202 7 20 2

RESUMO Introdução: A captação de tecidos musculoesqueléticos é fundamental para garantir o fornecimento de produtos biológicos de origem humana com segurança e eficácia clínica. Para assegurar a qualidade desses tecidos, é essencial que a etapa de captação passe por um processo de validação. Objetivos: Este artigo descreve a experiência de um banco de multitecidos humanos (BMTHs) público na validação da captação de tecido musculoesquelético (cabeça femoral) de doador vivo. Métodos: Trata-se da avaliação e adequação de um protocolo de captação visando promover a excelência na qualidade dos tecidos distribuídos para fins terapêuticos e de pesquisa. Para isso, foram realizadas uma visita técnica em outro banco de tecidos e reuniões com a equipe do serviço de ortopedia para apresentação e discussão sobre o fluxo do processo. A triagem do doador foi conduzida por meio da aplicação de formulários, avaliando os critérios de seleção e exclusão. Após a aceitação, mediante termo de consentimento, foram solicitados os exames sorológicos do doador e, por fim, a captação. Validaram-se o kit de captação, o controle de temperatura da caixa térmica de transporte e a coleta de material microbiológico da peça no momento da retirada. Para considerar válido o processo, o tecido captado passou por avaliações macroscópicas, radiológicas e microbiológicas. Os formulários e demais documentos do prontuário foram auditados pelo Núcleo de Qualidade e Segurança em Saúde (NQSS) da instituição. Também foi realizado o mapeamento dos processos, visando os riscos e oportunidades de melhoria. Resultados: O protocolo de captação foi realizado e validado conforme previsto no plano de ação. A técnica de captação foi realizada de forma estéril no centro cirúrgico. As análises microbiológicas e sorológicas apresentaram resultados negativos e o tecido foi considerado macroscopicamente viável. Após auditoria, a documentação foi considerada adequada ao atender a legislação vigente (Resolução da Diretoria Colegiada – RDC Nº 707, de 1 de julho de 2022). Além disso, o mapeamento dos processos garantiu a segurança da captação e proporcionou oportunidades de melhoria. Conclusão: Apresenta-se um protocolo de captação de tecidos musculoesqueléticos no serviço de referência, sendo o processo de validação replicável, por meio de uma ferramenta fundamental para assegurar a inocuidade e segurança na captação de tecidos. Descritores: Doação de Tecidos; Transplante de Tecidos; Controle de Qualidade Biológica; Produtos Inócuos; Banco de Tecidos Humanos. Introdução clínica Objetivos BMTHs (BMTHs cabeça femoral vivo Métodos Tratase Trata se pesquisa isso exclusão aceitação consentimento fim Validaramse Validaram retirada macroscópicas NQSS (NQSS instituição melhoria Resultados ação cirúrgico viável auditoria Resolução 707 2022. 2022 . 2022) disso Conclusão Apresentase Apresenta referência replicável Descritores Biológica Inócuos Humanos 70 202 7 20 2

ABSTRACT Artificial insemination success in swine is mainly associated with semen dose quality. Thus, this study compared quality control parameters in 11 Brazilian boar studs after applying audit services for 24 months (1,650 boars). An extensive checklist was applied in each audit, registering ‘compliance’ or ‘noncompliance’ for 75 items. Semen doses produced were analyzed as regards volume and sperm concentration, and microbiological analyses were conducted for semen and water samples collected at distinct production stages. On average, boar studs produced 112.9 semen doses per boar per month, and the odds of raw semen contamination increased when boars were inadequately housed and doses were collected under increased temperatures, with no anti-slip rubber mat or after a poor prepuce cleaning (p < 0.05). Collection from boars with locomotor problems and no regular change of reverse osmosis filters increased the contamination odds in semen doses produced and stored at the stud (p < 0.05). As regards the water submitted to the osmosis reverse process, contamination odds increased as a result of deficient cleaning and disinfection of the purification equipment (p < 0.05). Risk factors for reduced sperm motility (< 70 %) were: no anti-slip rubber mat for semen collection, no cleaning program for automatic feeding system (drops) and bins, and inadequate intervals between semen collections (≤ 2 days or > 7 days; p < 0.05). Two boar studs had the best results for compliance with the checklist items. Constant monitoring, appropriate hygiene of facilities and equipment, and periodical staff training are highlighted as non-negotiable points for boar semen dose quality. Thus 1 1,650 1650 650 (1,65 boars. . boars) ‘compliance ‘noncompliance noncompliance items concentration stages average 1129 112 9 112. month temperatures antislip anti slip 0.05. 005 0.05 0 05 0.05) process ( % collection drops (drops bins ≤ monitoring nonnegotiable non negotiable 1,65 165 65 (1,6 00 0.0 1,6 16 6 (1, 0. 1, (1

BACKGROUND: Irrational medicine use is a global problem that may potentiate antimicrobial resistance AIM: This study aims to assess prescribing practices and the effect of a prescription audit and feedback coupled with small-group education intervention on prescribing indicators SETTING: The study was conducted in public-sector healthcare facilities in Eswatini METHODS: A cluster quasi-randomised controlled study was conducted from 2016 to 2019 using the World Health Organization/ International Network for Rational Use of Drugs (WHO/INRUD) prescribing indicators at baseline, post-intervention and post-follow-up. A 6-month unblinded intervention was tested in 32 healthcare facilities, randomly allocated to intervention (16) and control (16) arms. Prescribing practices were assessed post-intervention, and 6 months after the intervention, through an audit of 100 randomly selected prescriptions from each facility. Comparisons of WHO or INRUD prescribing indicators were conducted using the intention-to-treat analysis at the two times RESULTS: At baseline, in both arms, rational prescribing standards were met by the number of medicines per prescription and the use of injections. Antibiotic use was above 50% in both arms. After adjustment for baseline antibiotics use, region and level of care, there were no significant differences in all prescribing indicators between the two arms, post-intervention and at 6 months follow-up CONCLUSION: In a lower middle-income setting with a high prevalence of irrational prescribing practices, a prescription audit, feedback and small-group education intervention had no benefits in improving rational prescribing CONTRIBUTION: Multifaceted strategies, strengthening of pharmacy and therapeutics committees, and holistic monitoring of medicine use are recommended to promote rational medicine use

Resumen Introducción Derivado de la pandemia del COVID-19, la prevalencia de estrés, ansiedad, depresión y consumo de alcohol ha incrementado entre los estudiantes de medicina. La intervención por Mindfulness ha reportado disminuir estas psicopatologías y el consumo de alcohol; no obstante, la evidencia muestra resultados poco claros respecto a su eficacia. Objetivo Evaluar la eficacia de la intervención basada en Mindfulness online (IBM) sobre los niveles de sintomatología de estrés, ansiedad y depresión, así como en el consumo de alcohol y el estado de atención plena en estudiantes de medicina durante la pandemia por COVID-19. Método Se realizó una investigación cuasi-experimental en 237 estudiantes de medicina, de los cuales se obtuvieron datos sociodemográficos; además, se midieron los niveles de psicopatologías, consumo de alcohol, y el estado de atención plena pre y post intervención a través de los instrumentos DASS-21, AUDIT, y MASS. Se llevaron a cabo ocho sesiones de Mindfulness online, una vez por semana, de aproximadamente una hora cada una. Resultados La IBM no redujo los niveles de psicopatologías ni de consumo de alcohol ni mejoró el estado de atención plena. Los altos niveles de psicopatologías, la tasa de abandono y la falta de participación voluntaria, fueron los principales factores que limitan la eficacia del IBM online. Discusión y conclusión La IBM online no fue efectiva entre la población estudiada: se recomienda la generación de estrategias en las que los estudiantes se involucren y completen los programas de intervención, los resultados de esta investigación ayudarán a mejorar futuras intervenciones de mindfulness online.

Abstract Introduction As a result of the COVID-19 pandemic, the prevalence of stress, anxiety, depression, and alcohol consumption has increased among medical students. Mindfulness is an intervention to decrease these psychopathologies and alcohol consumption; however, evidence has shown unclear results regarding its efficacy. Objective To evaluate the effectiveness of an online Mindfulness-based intervention (MBI) on stress, anxiety, and depression symptomatology levels, as well as on alcohol consumption and mindfulness status in medical students during the COVID-19 pandemic. Method A quasi-experimental study was conducted on 237 students, obtaining sociodemographic data. In addition the levels of psychopathology, alcohol consumption, and state of mindfulness: were measured pre-and post-intervention through the DASS-21, AUDIT, and MASS instruments. Eight online Mindfulness sessions were conducted once a week for approximately one hour each. Results MBI did not reduce levels of psychopathologies or alcohol consumption, nor did the mindfulness status improve. High levels of psychopathologies, dropout rate, and lack of voluntary participation were the main factors limiting the effectiveness of the online MBI. Discussion and conclusion The online MBI wasn’t effective among the population under study: we recommend generation strategies where students are involved in and complete intervention programs. Results from this research will help enhance future online mindfulness interventions.

RESUMEN Objetivos: describir la percepción de los enfermeros acerca de la influencia de la supervisión clínica en la mejoría de los indicadores de calidad en la atención de enfermería. Métodos: investigación exploratoria de enfoque calitativo, realizada con 16 enfermeros utilizando el focus group. El procesamiento de datos emergió del análisis textual lexicográfico, recurriendo a la Clasificación Jerárquica Descendiente y análisis de similitud. Resultados: retención de 80,0% de 185 segmentos de texto con construcción de seis clases. Las palabras fueron representadas por cuatro grafos (supervisor, auditoría, cuidado y proceso); y tres subgrafos (implementación, partición y conocimiento). Consideraciones Finales: en la percepción de los enfermeros, la supervisión influencia los indicadores de calidad en la atención de enfermería. Objetivos enfermería Métodos calitativo 1 group lexicográfico similitud Resultados 800 80 0 80,0 18 clases supervisor, supervisor (supervisor auditoría proceso proceso) implementación, implementación (implementación conocimiento. conocimiento . conocimiento) Finales 8 80,

ABSTRACT Objectives: to describe nurses’ perception of the influence of clinical supervision on improving quality indicators in nursing care. Methods: exploratory research with a qualitative approach, carried out with 16 nurses using the focus group. Data processing emerged from lexicographical textual analysis, resorting to Descending Hierarchical Classification and similarity analysis. Results: 80.0% retention of 185 text segments with six-class construction. The words were represented by four graphs (supervisor, audit, care, and process); and three subgraphs (implementation, sharing and knowledge). Final Considerations: in the perception of nurses, supervision influences quality indicators in nursing care. Objectives care Methods approach 1 group analysis Results 800 80 0 80.0 18 sixclass six class construction supervisor, supervisor (supervisor audit process process) implementation, implementation (implementation knowledge. knowledge . knowledge) Considerations 8 80.

RESUMO Objetivos: descrever a percepção dos enfermeiros acerca da influência da supervisão clínica na melhoria dos indicadores de qualidade na assistência de enfermagem. Métodos: pesquisa exploratória de abordagem qualitativa, realizada com 16 enfermeiros utilizando o focus group. O processamento de dados emergiu da análise textual lexicográfica, recorrendo à Classificação Hierárquica Descendente e análise de similitude. Resultados: retenção de 80,0% de 185 segmentos de texto com construção de seis classes. As palavras foram representadas por quatro grafos (supervisor, auditoria, cuidado e processo); e três subgrafos (implementação, partilha e conhecimento). Considerações Finais: na percepção dos enfermeiros, a supervisão influencia os indicadores de qualidade na assistência de enfermagem. Objetivos enfermagem Métodos qualitativa 1 group lexicográfica similitude Resultados 800 80 0 80,0 18 classes supervisor, supervisor (supervisor auditoria processo processo) implementação, implementação (implementação conhecimento. conhecimento . conhecimento) Finais 8 80,

ABSTRACT This article analyzes the leader's management style effect on the relationship between personal factors and role conflict in the internal audit function. It sheds light on the factors per se regarding the presence of role conflict in internal audit, addressing the effects that various management styles of the audit leader can cause in the relationship previously addressed in the literature between personal characteristics and role conflict. Evidence shows that the skills and expertise of leading internal audit executives impact the role played by internal auditors, becoming major insights to be analyzed and understood when delimiting the internal audit function. This article contributes to grasping the impact that aspects at a personal, professional, and interaction level in the management hierarchy in companies can have on the internal audit function. A survey was used involving 218 internal auditors certified by the Institute of Internal Auditors of Brazil (Instituto dos Auditores Internos do Brasil [IIA Brasil]), working in the internal audit area and with active profiles on the professional networking platform LinkedIn. Use of multiple linear regression for data analysis. Personal factors encompass the independence and expertise of internal auditors. Role conflict comprises three dimensions: demand from the organization vs. the auditor profession; auditing vs. consulting; and personal values vs. professional expectations. Management style measures the behavior of immediate superiors in the dimensions of task, relationship, and situational context. As results and contributions, it was evidenced that internal auditor’s commitment to independence and expertise have a negative influence on role conflict. A management style with behaviors aimed at relationships between individuals, carrying out tasks, or adapting to situations, on the part of immediate superiors, contributes to reducing the level of role conflict in the internal audit function. leaders s function 21 Instituto IIA Brasil, , Brasil]) LinkedIn analysis vs profession consulting expectations task context contributions individuals tasks situations 2 Brasil]

RESUMO Este artigo analisa o efeito do estilo de gestão do líder na relação entre os fatores pessoais e o conflito de papéis na função da auditoria interna. Lança-se luz sobre os fatores per se da presença de conflito de papéis na auditoria interna, abordando os efeitos que diferentes estilos de gestão do líder da auditoria podem ocasionar na relação precedentemente já investigada na literatura entre características pessoais e o conflito de papéis. As evidências demonstram que as habilidades e expertise de executivos líderes da auditoria interna impacta o papel exercido pelos auditores internos, tornando-se insights importantes de serem analisados e compreendidos ao delimitar a função da auditoria interna. Este artigo contribui com a compreensão do impacto que aspectos a nível pessoal, profissional e de interação na hierarquia de gestão nas empresas podem ocasionar na função da auditoria interna. Foi usada pesquisa survey envolvendo 218 auditores internos certificados pelo Instituto dos Auditores Internos do Brasil (IIA Brasil), atuantes na área de auditoria interna e com perfis ativos na plataforma de contatos profissionais LinkedIn. Utilização de regressão linear múltipla para a análise dos dados. Os fatores pessoais englobam a independência e expertise dos auditores internos. O conflito de papéis contempla três dimensões: demanda da organização vs. profissão de auditor; auditoria vs. consultoria; e valores pessoais vs. expectativas profissionais. O estilo de gestão mensura o comportamento dos superiores imediatos nas dimensões de tarefa, relacionamento e contexto situacional. Como resultados e contribuições, evidenciou-se que o compromisso com a independência e a expertise dos auditores internos têm influência negativa no conflito de papéis. Um estilo de gestão com comportamentos direcionados ao relacionamento entre os indivíduos, à realização das tarefas ou adaptativo às situações, por parte dos superiores imediatos, contribui para reduzir o nível de conflito de papéis na função da auditoria interna. Lançase Lança tornandose tornando pessoal 21 IIA Brasil, , Brasil) LinkedIn dados vs auditor consultoria tarefa situacional contribuições evidenciouse evidenciou indivíduos situações 2

BACKGROUND: Serum protein electrophoresis (SPE), urine protein electrophoresis and immunofixation electrophoresis were traditionally utilised for the diagnosis of monoclonal gammopathies. The quantitative serum-free light chain (SFLC) assay is reportedly more sensitive and has been introduced to recent clinical guidelines. OBJECTIVE: This study aimed to investigate SFLC test utilisation and describe SPE findings in patients with abnormal SFLC ratios. METHODS: A retrospective audit of SFLC analyses was conducted in Cape Town, South Africa, from May 2018 to April 2020. Agreement between abnormal SFLC ratios and SPE results was determined in a sub-group of patients screened for monoclonal gammopathies. Serum-free light chains were analysed using Freelite® Kappa and Lambda assays. RESULTS: Of the 1425 patients included in the audit, 741 (52%) had abnormal SFLC ratios; 636 (45%) had increased and 105 (7%) had decreased SFLC ratios. In a sub-group analysis of 117 new patients with an abnormal SFLC ratio, 57 had a monoclonal protein (M-protein) on SPE (49%), and 60 (51%) did not. Four out of 60 patients without M-protein had a plasma cell dyscrasia, while renal impairment or inflammatory response accounted for the rest. Of the 57 patients with a M-protein and abnormal SFLC ratio, 41 (72%) had a plasma cell dyscrasia, seven (12%) had lymphomas and nine patients (16%) were unclassifiable. CONCLUSION: Serum-free light chains should be requested when there is a high index of clinical suspicion. Neither SFLC nor SPE should be performed in isolation when screening patients for monoclonal gammopathy, to ensure that no patient is missed WHAT THIS STUDY ADDS: The study adds to the evidence on SFLC test utilisation. Serum protein electrophoresis alone may miss cases of light chain myeloma, while SFLC performed in isolation may produce false positive results in the setting of inflammatory disorders or renal impairment, leading to unnecessary further investigation.

BACKGROUND: Continuing professional development (CPD) activities relevant to medical doctors and their patients should be informed by current assessed training needs. The CPD provision is expected to improve the quality of professional practice and ethics. However, the Uganda Medical and Dental Practitioners' Council still receives about 40 reports of malpractice every month AIM: The study aimed to describe the CPD training needs of doctors working in public primary care facilities in central Uganda SETTING: The district health system of central Uganda comprised 10 General Hospitals (GH) and 37 Health Center IVs (HC IVs) with a staffing norm of six and two doctors, respectively METHODS: This was a cross-sectional survey of 100 doctors working in public primary care facilities using the World Health Organization (WHO) Hennessy-Hicks questionnaire. Descriptive statistics of the importance, current performance, and training need of each skilled activity were calculated. Content analysis was applied to data from the open-ended questions RESULTS: The response rate was 91%, majority were males, 80 (87.9%) from 7 GHs and 24 HC IVs with an average age of 37.9 years. The domain with the highest CPD training need for the doctors was research and audit, with a mean score (standard deviation [s.d.]) of 1.94 (±1.69), followed by administration 1.58 (±1.61) and clinical tasks 1.28 (±1.29). The clinical tasks domain had the most suggested CPD topics CONCLUSION: Research and audit and clinical tasks were identified as important domains for CPD training for doctors in this setting CONTRIBUTION: The results give insight into CPD training needs of primary care doctors and guide various CPD providers

BACKGROUND: Abdominal pain is a common complaint in the Emergency Department. Radiographers' knowledge and practices regarding clinical indications for performing abdominal examinations are crucial in the results radiographs produced AIM: To determine the knowledge and practices of radiographers regarding the clinical indications for performing radiographic examinations of the abdomen SETTING: Four public hospitals in the Eastern Cape province, South Africa METHODS: A cross-sectional study was conducted, using a convenience, all-inclusive sample of n = 85 radiographers. A hard copy self-administered questionnaire was distributed between February and June 2020. Descriptive (mean and standard deviations) and inferential (chi² test) statistics were generated using IBM® SPSS® version 26.0 software package RESULTS: Knowledge of clinical indications had a mean of 59.41. All four demographics (age, years of experience, attended a short course and attended pattern recognition course) were significantly associated with overall knowledge. Additionally, short course attendance was significantly associated with most practice items, and two knowledge items (which views are done for perforation; and which view(s) demonstrate a stab abdomen). Pattern recognition was significantly associated with one knowledge item (which views are regarded as an acute abdomen CONCLUSION: Despite the lack of short courses and pattern recognition courses, radiographers' knowledge of clinical indications was good (>50%). Continuous training, accessible protocols for performing clinical indications for plain abdominal radiographic examinations for radiographers, audit, feedback and reminders to enhance protocol adherence are recommended CONTRIBUTION: The study findings could be used to enhance knowledge and practices regarding clinical indications for plain abdominal radiographic examinations among radiographers

Abstract “The recognition of environmental auditing as an instrument of environmental management in the Cuban legal system will favor compliance with corporate social responsibility in correspondence with the requirements of environmental protection in Cuba” is the hypothesis that is validated with the research that develops the following objectives: analyze the environmental audit, as well as its regulation in the Cuban legal system from a historical-legal and doctrinal approach; and substantiate the need for its legal organization as an instrument of environmental management. The methodology was based on a review of different doctrinal and normative sources with an analytical-synthetic approach and on the exegesis of the current norms. We start from the theoretical study of Corporate Social Responsibility; and the environmental audit and its antecedents in the national legal system to substantiate the need for its regulation as an instrument of environmental management based on the development of socially responsible companies. Also, legal theoretical bases are established for a regulation proposal of this institute, more than, as a control action, as an environment management tool. As a result, a foundation of the need to recognize the environmental audit in the Cuban legal system is achieved as an essential management instrument for the fulfillment of the social responsibility of the different economic actors under the strict observance of the environmental protection policy and regulations.

Resumen “El reconocimiento de la auditoría ambiental como instrumento de la gestión ambiental en el ordenamiento jurídico cubano favorecerá el cumplimiento de la responsabilidad social empresarial en correspondencia con los requerimientos de la protección del medio ambiente en Cuba” es la hipótesis que se valida con la investigación que desarrolla los siguientes objetivos: analizar la auditoría ambiental, así como su regulación en el ordenamiento legal cubano desde un enfoque histórico-jurídico y doctrinal; y fundamentar la necesidad de su ordenación jurídica como instrumento de gestión del ambiente. La metodología se basó en una revisión de diferentes fuentes doctrinales y normativas con un enfoque analítico-sintético y en la exégesis de las normas vigentes. Partimos del estudio teórico de la Responsabilidad Social Empresarial; y de la auditoría ambiental y sus antecedentes en el ordenamiento jurídico patrio para fundamentar la necesidad de su regulación como instrumento de la gestión ambiental en función del desarrollo de empresas socialmente responsables. También, se establecen bases teórico jurídicas para una propuesta de regulación de este instituto, más que, como una acción de control, como una herramienta de gestión del ambiente. Como resultado se logra una fundamentación de la necesidad de reconocer la auditoría ambiental en el ordenamiento jurídico cubano como instrumento de gestión indispensable para el cumplimiento de la responsabilidad social de los diferentes actores económicos bajo la estricta observancia de la política y normativas protectoras del medio ambiente.

Abstrato Introdução: O consumo de álcool e tabaco é um problema de saúde pública mundial que afeita adolescentes e jovens. No México, ocupa a décima posição com um consumo de álcool per capita de 7,2 litros e aproximadamente 14,9 milhões de mexicanos são atualmente fumadores. Objetivo: Analisar a relação entre a percepção de risco e o consumo de álcool e tabaco em estudantes universitários de ciências da saúde de uma universidade pública de Tabasco, México. Metodologia: Estudo descritivo correlacional, numa amostra de 601 estudantes selecionados por amostragem estratificada de probabilidade. Com critérios de seleção: ser matriculado no programa de enfermagem, medicina ou odontologia, instrumentos incompletos ou aqueles que abandonaram o estudo foram eliminados. Foram aplicados um questionário de dados pessoais e prevalência do consumo de álcool e tabaco, um questionário de percepção de risco para o consumo de drogas lícitas e um teste de auditoria, garantindo o anonimato, a confidencialidade dos dados e o direito de recusar a participação. Resultados: O consumo médio foi de 3,6 bebidas alcoólicas e 2,5 cigarros por ocasião. Houve uma relação negativa estatisticamente significativa entre a percepção de risco e o número de cigarros consumidos com p<.05 e o consumo de álcool com p<.01. Conclusões: O consumo de álcool e tabaco está presente nos estudantes universitários de ciências da saúde, pelo que devem ser estabelecidas intervenções de enfermagem sobre a percepção de risco do consumo, a fim de ter um impacto no fenómeno das dependências.

Abstract Introduction: Alcohol and tobacco consumption are a worldwide public health problem that affects adolescents and young people. Mexico is in tenth place with a per capita consumption of 7.2 liters of alcohol, and currently, approximately 14.9 million Mexican people are smokers. Objective: Evaluate the relationship between risk perception and alcohol and tobacco consumption in university students of health sciences at a public university in Tabasco, Mexico. Methodology: This is a descriptive correlational study, with a sample of 601 students selected by stratified probability sampling. Selection criteria: to be enrolled in nursing, medicine or dentistry programs; incomplete instruments and those who dropped out of the study were removed. The questionnaire of personal data and prevalence of alcohol and tobacco consumption, the questionnaire of risk perception towards licit drug consumption and the Audit test were applied, guaranteeing anonymity, data confidentiality and the right to refuse to participate. Results: The average consumption was 3.6 alcoholic beverages and 2.5 cigarettes per occasion. There was a statistically significant negative relationship between risk perception and number of cigarettes consumed (p<.05) and alcohol consumption (p<.01). Conclusions: The consumption of alcohol and tobacco is present in university students of health sciences; therefore, nursing interventions on the perception of risks of consumption should be established in order to have an impact on the phenomenon of addictions.

Resumen Introducción: El consumo de alcohol y tabaco son un problema de salud pública a nivel mundial que afecta a adolescentes y jóvenes. En México ocupa el décimo lugar con un consumo de 7.2 litros per cápita de alcohol y aproximadamente 14.9 millones de mexicanos son fumadores actualmente. Objetivo: Analizar la relación de percepción de riesgo y consumo de alcohol y tabaco en estudiantes universitarios de ciencias de la salud de una universidad pública en Tabasco, México. Metodología: Estudio descriptivo correlacional, en una muestra de 601 estudiantes seleccionados por muestreo probabilístico estratificado. Con criterios de selección: estar inscrito en el programa de enfermería, medicina u odontología, se eliminaron instrumentos incompletos o quien abandonó el estudio. Se aplicó cédula de datos personales y prevalencia de consumo de alcohol y tabaco, cuestionario de percepción de riesgo hacia el consumo de drogas lícitas y prueba Audit, garantizando anonimato, confidencialidad de datos y derecho de negarse a participar. Resultados: La media de consumo fue 3.6 en bebidas alcohólicas y 2.5 cigarrillos por ocasión. Existió relación negativa estadística significativa entre la percepción de riesgo con cantidad de cigarrillos consumidos con p<.05 y consumo de alcohol con p<.01. Conclusiones: El consumo de alcohol y tabaco se encuentra presente en los estudiantes universitarios de ciencias de la salud, por ello, se deben establecer intervenciones de enfermería sobre la percepción del riesgo del consumo para impactar en el fenómeno de las adicciones.

ABSTRACT The use of natural products for medicinal use has increased in recent years worldwide, Ecuador has followed this trend, many of these products are freely marketed, without a guarantee of safety since a large part of them do not have a certification of Good Manufacturing Practices (GMP), which is a mandatory parameter for any industry that produces natural products for medicinal use. The present article shows the steps to follow from the initial internal audit to verify the status of the company La Colmena based on the Check List which is granted by ARCSA, Ecuador (Agency for Regulation and Sanitary Control) where list the points to be met to obtain the BPM certification and its measures to correct the non-conformities found. The company La Colmena presented 25% of successful parameters in the initial internal audit, once the corrective actions were carried out, 83% compliance was presented, which guarantees that the company provides the market with quality and safe products for consumption. This work aims to develop a GMP protocol to be a guide for other companies in the same sector and qualification.

RESUMEN El uso de productos naturales medicinales se ha incrementado en los últimos años a nivel mundial, Ecuador sigue esta tendencia, aunque muchas mercancías se comercializan sin certificación de Buenas Prácticas de Manufactura (BPM), el cual es parámetro obligatorio en el país. El artículo muestra los pasos para constatar el estado de la empresa La Colmena en base una lista de chequeo otorgada por la Agencia de Regulación y Control Sanitario (ARCSA, Ecuador) que detalla los puntos para la obtención de la certificación BPM. Dicha empresa presentó un 25% de cumplimientos en la auditoría interna inicial; pero al realizar las acciones correctivas, posee un 83% de cumplimiento, que garantiza que se brinden productos de calidad e inocuos para su consumo. El presente trabajo pretende desarrollar un protocolo de BPM que sea una guía para otras empresas del sector.

ABSTRACT Objective To evaluate and establish the statistical correlation of the sanitary and microbiological quality of acid whey. Methods Whey samples were obtained from dairy companies in Belén, Boyacá, Colombia. Quality audits were performed, and microbiological counts were determined. Both were analyzed by quality control charts to assess compliance and variability. Correlation analyses between the microbiological results and Good Manufacturing Practices (GMP) were established. Results The averages of microbiological variables at the time of evaluation showed that companies did not comply with the standard. The aerobic mesophiles and total coliform counts were different (p<0.05) before and after the improvement plan. Thermo-tolerant coliforms, mold, and yeast counts showed significant differences in the Kruskal Wallis test, but not in the Wilcoxon test (p>0.05). This indicates that CFU/mL are constant in the process line. According to INVIMA, the minimum pass rate for GMP compliance is >60 %. In the first audit, 42 % of the GMP criteria obtained unfavorable concepts, and 67 % of the companies were above 60 % and below 80 %. Negative correlations were found when comparing microbiological counts and the GMP compliance requirements. The "quality assurance and control" obtained the highest number of negative correlations and showed a deficit in the effectiveness and verification of GMP. Conclusions Health-quality indicator microorganism counts in acid whey tend to prevail and increase due to deficiencies in GMP; they also condition the quality of whey for subsequent uses.

RESUMEN Objetivo Evaluar y establecer la correlación estadística de la calidad sanitaria y micro-biológica del suero ácido. Métodos Las muestras de suero fueron obtenidas de empresas lácteas en Belén, Boyacá, Colombia. Se realizaron auditorías de calidad y se determinaron recuentos microbiológicos que fueron analizados en gráficos de control de calidad para evaluar el cumplimiento y la variabilidad. Se establecieron análisis de correlación entre los resultados microbiológicos y los criterios de buenas prácticas de manufactura (BPM). Resultados Los promedios de las variables microbiológicas en los momentos de evaluación evidenciaron incumplimiento de la norma en las empresas. El recuento de aerobios mesófilos y coliformes totales es diferente (p<0,05) antes y después del plan de mejoras. Los recuentos de coliformes termotolerantes, mohos y levaduras presentaron diferencias significativas en la prueba de Kruskal Wallis, pero no en el Test de Wilcoxon (p>0,05), esto indica que las UFC/mL son constantes en la línea de proceso. De acuerdo con el Invima, el porcentaje mínimo aprobatorio para el cumplimiento de las BPM es >60 %. En la primera auditoria, el 42 % de los criterios de BPM registraron conceptos desfavorables y el 67 % de las empresas obtuvieron un puntaje por encima del 60 % e inferior al 80 %. Se registraron correlaciones negativas al comparar los recuentos microbiológicos y el cumplimiento de los criterios de BPM. El criterio "aseguramiento y control de la calidad" obtuvo el mayor número de correlaciones negativas y deja ver un déficit en la eficacia y verificación de las BPM. Conclusiones Los recuentos de microorganismos indicadores de calidad sanitaria en el lactosuero ácido tienden a prevalecer y aumentar debido a las falencias en el cumplimiento de las BPM y condicionan la calidad del suero para usos posteriores.