Doutorado em Ciências da Saúde (FM)
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Navegando Doutorado em Ciências da Saúde (FM) por Por Orientador "Amaral, Rita Goreti"
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Item Impacto da educação continuada realizada pelo laboratório de monitoramento externo da qualidade na acuidade dos resultados dos exames citopatológicos do colo do útero(Universidade Federal de Goiás, 2014-03-21) Ázara, Cinara Zago Silveira; Manrique, Edna Joana Cláudio; http://lattes.cnpq.br/7574704691846518; Amaral, Rita Goreti; http://lattes.cnpq.br/3665611660713029; Amaral, Rita Goreti; Conde, Délio Marques; Guimarães, Janaína Valadares; Barbosa, Maria Alves; Feres, Valéria Christina de RezendeThe effectiveness of cytopathology exams demands high quality training, continued education and highly skilled professionals to guarantee a reliable, accurate exam, aimed at reducing false results. Objective: To evaluate the effect of a continued education program conducted by the External Quality Control Monitoring Laboratory (LabMEQ), assessing the agreement of the results and internal quality control indicators. Methods: To analyze the agreement of the results, 19,826 exams conducted between 2007 and 2011 and selected through the cervical cancer data system (SISCOLO) were evaluated, 9,798 of these exams having been performed prior to the implementation of continued education and 10,028 after implementation. The statistical analysis was performed using the chi-square test, with p-values < 0.05 being considered statistically significant and the kappa coefficient was calculated. To analyze the internal quality control indicators, 185,194 exams performed between 2007 and 2012 were evaluated. Data for these exams were obtained from the SISCOLO, with 98,133 having been performed prior to the implementation of continued education and 87,061 after implementation. The following indicators were calculated: positivity index (PI), percentage of exams compatible with a high-grade squamous intraepithelial lesion (HSIL/satisfactory), percentage of atypical squamous cells among all abnormal smears (ASC/abnormal) and the ratio between atypical squamous cells and intraepithelial lesions (ASC/SIL). Continued education was provided every two months to the professionals from the participating laboratories in the form of theoretical and practical classes to discuss discordant cases and the standardization of cytomorphological criteria. Results: After the implementation of continued education, a reduction was found in the percentage of false-negative results that lead to delays in clinical management in eight laboratories and there was an improvement in the rate of false-positive results in five. There was no improvement observed in the unsatisfactory results. The agreement of the cytopathology exam results, according to the clinical management, remained excellent in three laboratories (kappa > 0.80), increased from good (kappa > 0.60 and < 0.80) to excellent (kappa > 0.80) in seven and from excellent to good in two laboratories. The agreement in the identification of the metaplastic epithelium, which was poor (kappa = 0.25), was classified as excellent after implementation of the continued education program (kappa = 0.95). The agreement of the results, according to the diagnosis, improved significantly following continued education in unsatisfactory cases (p<0.001), in cases of atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot exclude HSIL (p<0.001), low-grade squamous intraepithelial lesions (p<0.001) and atypical glandular cells (p<0.001). Following implementation of the continued education program, the positivity index (PI) remained within recommended limits in four laboratories. In another four laboratories, the PI progressed from below the limits to within the recommended standards. In one laboratory, the PI remained low, in two laboratories, it remained very low, and in one, it increased from very low to low. The HSIL/satisfactory remained within the recommended limits in five laboratories, while in three laboratories it progressed from below the recommended levels to >0.4% of the total number of satisfactory exams, and in four laboratories it remained below the standard limit. Both the percentage of ASC/abnormal and the ratio ASC/SIL remained within recommended levels in all the laboratories investigated. Conclusion: The results of this study show that the continued education program conducted by LabMEQ with the laboratories was effective as a measure aimed at standardizing cytomorphological criteria, since there was an improvement in the reproducibility of the results and in the indicators of internal quality control, leading to a reduction in the number of false results.Item Descrição e avaliação de um modelo de serviço de dispensação de uma Farmácia Universitária em Goiânia, Goiás, Brasil(Universidade Federal de Goiás, 2013-12-13) Ferreira, Tatyana Xavier Almeida Matteucci; Dewulf, Nathalie de Lourdes Souza; Amaral, Rita Goreti; http://lattes.cnpq.br/3665611660713029; Mastroianni, Patricia de Carvalho; Zampieri, Ana Lúcia Teixeira de Carvalho; Garrote, Clévia Ferreira Duarte; Provin, Mércia Pandolfo; Lima, Dione MarçalBackground: Although dispensing of medication has been addressed on theoretical models, studies that confirm the impact of this service are still needed. Objective: to describe and evaluate a model of medicine dispensing developed and implemented in a pharmacy in accordance with the parameters of structure, process and outcome. Methods: This was a descriptive, observational and quasi-experimental study performed in a Campus Pharmacy, approved by the Ethics Committee in Research of the Federal University of Goiás under protocol 222/2012. one hundred and four patients attending the dispensing service of the campus pharmacy between 21 January 2013 and 20 April 2013 were included in this quasi-experimental study. The description and assessment of the service was performed in terms of the three parameters: structure, process and outcome, used by Donobedian to evaluate the quality of medical care and adapted by Farris & Kirking to evaluate the quality of pharmaceutical care. The description and assessment of each parameter was performed as recommended by the Ministry of Health of Brazil, international agencies and previous studies. Assessment of knowledge about medicine prescription and adherence, before and after medicine dispensing, was performed by McNemar’s test. Associations between variables were assessed by the Wald test. A p-value <0.05 was considered to be statistically significant. Results: Medicine dispensing improved patient’s knowledge about medications (P<0.05), which was associated with pharmacotherapy complexity (P<0.05). The main problems identified were related to lack of patient’s knowledge regarding their medication (52.9%). Pharmaceutical interventions were mostly performed directly to the patients (86.3%) by verbal (95.4%) and written (68.2%) information, and most of the problems were completely solved (62.7%). Pharmacy service was evaluated as “excellent” or “very good” by more than 70% of patients, and a high level of satisfaction was observed. Improvement of medication adherence, however, was not observed. Conclusion: the medicine dispensing model was able to identify and solve drug-related problems and promote an improvement in patient’s knowledge about medication.Item O acesso a medicamentos pela via administrativa no setor público de saúde no Brasil(Universidade Federal de Goiás, 2015-05-08) Soares, Amanda Queiroz; Provin, Mércia Pandolfo; http://lattes.cnpq.br/1809891256443044; Amaral, Rita Goreti; http://lattes.cnpq.br/3665611660713029; Amaral, Rita Goreti; Dâmaso, Andréa Homsi; Andrade, Eli Iola Gurgel; Medeiros, Marcelo; Contezini, Silvana Nair LeiteAlthough the Brazilian public healthcare system is based on the principles of the universality and integrality of access to health services, severe problems remain with respect to guaranteeing access to pharmaceutical drugs. This situation has contributed to the creation of new institutional frameworks, including the administrative channel, institutionalized by the executive power with the aim of meeting the repressed demand for pharmaceutical drugs not obtained within the public health service. This study analyzed access to pharmaceutical drugs through the administrative channel within the Brazilian public health sector. As part of this larger study, various methodologies were applied, including a case-control study, a descriptive study and an interpretive case study in which the focal group technique was used. The study was developed in the town of Goiânia, in Brazil’s mid-western region. General users of primary healthcare units (or their accompanying persons), users specifically requesting pharmaceutical drugs through the administrative channel and users who had successfully obtained pharmaceutical drugs through this channel participated in the study. Results show that administrative demands for access to pharmaceutical drugs are inserted within a multifactorial context that involves users’ economic and sociodemographic characteristics, as well as the characteristics of healthcare, pharmaceutical care and healthcare conditions. Furthermore, users who had gained access to at least one pharmaceutical drug requested through the administrative channel were found to be predominantly those who were less socioeconomically vulnerable, those with a positive self-evaluation of their state of health, those requesting insulin analogs and individuals who in general did not consult or obtain medication within the public healthcare sector. The steps taken by most of the individuals who had their request approved reveal their fluidity between the public and private healthcare sectors, characterizing their efforts to guarantee healthcare. Therefore, the administrative channel was found not to be free from the barriers to achieving access to pharmaceutical drugs that exist within the public health sector in view of its interdependency on a system with shortcomings both within the health sector itself and at higher levels within the system.