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- ItemSomente MetadadadosA compreensão do residente médico, em reumatologia, no atendimento ao paciente com fibromialgia(Universidade Federal de São Paulo (UNIFESP), 2007) Canzonieri, Ana Maria [UNIFESP]; Pollak, Daniel Feldman [UNIFESP]
- ItemAcesso aberto (Open Access)Conhecimentos e atitudes de cirurgiões frente aos conceitos de terapia nutricional(Colégio Brasileiro de Cirurgiões, 2013-10-01) Paulo, Danilo Andriatti [UNIFESP]; Oliveira, Bruno Mauricio Rodrigues de [UNIFESP]; Wang, Davi Wei Ming [UNIFESP]; Guimarães, Maysa Penteado [UNIFESP]; Cukier, Celso [UNIFESP]; Lopes Filho, Gaspar de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To compare the knowledge of nutritional therapy (NT) of surgery residents and surgeons. METHODS: We applied two standardized questionnaires on knowledge, attitude and behavior regarding NT to 50 physicians (35 residents and 15 surgeons) of 12 different surgical areas. We compared the proportions of hits according to the perception on the subject of each group using the Fisher exact test, with 5% significance and p < 0.05. RESULTS: More than 80% did not feel safe regarding NT and 46% denied knowledge of the NT multidisciplinary team (NTMT). There was a higher percentage of correct answers among residents in the items: surgical trauma and its nutritional influence on the patient (p = 0.047); normal BMI (p = 0.036); preoperative NT (p = 0.007); and indication of preoperative NT in the group that referred that to interact with the NTMT (p = 0.02). Among surgeons: complications of NT and NT in previously malnourished patients (p = 0.044); and methods for assessing preoperative nutritional status in the group that referred to interact with the NTMT (p =0.01). CONCLUSION: there are gaps in medical education. Only 13.3% were confident about NT, and their knowledge did not justify such confidence. There were no differences between the successes of confident and non-confident about NT in most subjects. The best results came from the group that claimed to be assisted by any NTMT. Better medical educational programs should be goal for this university.
- ItemAcesso aberto (Open Access)Os médicos e a racionalização das práticas hospitalares: novos limites para a liberdade profissional?(Universidade Federal de São Paulo (UNIFESP), 2010-04-28) Abou Jamra, Carolina Chaccur [UNIFESP]; Cecilio, Luiz Carlos de Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Brazilian hospitals, either in public or private sectors, have experienced a remarkable rationalization process in their practices through strategies aimed at regulate, discipline and control the diverse dimensions of hospital life. Such strategies convey a specific, instrumental rationality that is outlined by the search for greater institutional efficiency and effectiveness. Regarding the existence of a dual system of authorities in hospitals composed by both medical and administrative powers, the introduction of a rationalizing logic by the hospital administration potentially impacts the power of decision-making within the clinical board, whose professionals, on their turn, activate autonomy conservation strategies ultimately concerned with the maintenance of their power in the institution. The present study is aimed at understanding how medical doctors experience and assign meaning to the rationalizing hospital management policies implemented by the management board of a hospital belonging to the State Health Department of São Paulo. This hospital is managed by a university through a formal agreement as a teaching hospital. It is also certified by the National Accreditation Organization as an institution of excellence. As a case study carried out through an analytical qualitative methodology, which, from semi-structured interviews performed with six medical doctors directly concerned with health care, this research is able to identify an apparent paradox involving the evident advancement of the institutional mechanisms of control over medical work as well as the ―subjective‖ perception of such advancements by the physicians, who do not recognize them as limits for their technical autonomy. In addition, it demonstrates how far the resistance of physicians against the rationalizing measures is made in act, when performing their work, when creating informal networks of contact and knowledge, which follow through by producing flows, ways of operation for the hospital, ways of producing care, which go far beyond the rationality, the formalism, and the previsibility as aimed by the administration.