http://bdtd.uftm.edu.br/handle/tede/612 2026-10-08T06:41:53Z http://bdtd.uftm.edu.br/handle/123456789/2161 Título: Construção colaborativa de algoritmo de tomada de decisão para implantação de serviço de farmácia clínica em oncologia Abstract: Introduction: Cancer is the second leading cause of death worldwide, posing a challenge to public health systems. In Brazil, the SUS (Unified Health System) has prioritized strengthening cancer care, notably through the National Policy for Cancer Prevention and Control (Law No. 14,758/2023), the Cancer Prevention and Control Network (GM/MS Ordinance No. 6,591/2025), and the creation of the Pharmaceutical Assistance Component in Oncology - AF-Onco (Ordinance No. 8,477/2025). In this context, clinical pharmacy in oncology emerges as a strategy to improve care, promoting patient safety, therapeutic adherence, and cost control. However, decision-making regarding its implementation in public hospitals lacks objective and standardized instruments aligned with the specificities of the SUS. Simultaneously, the DATASUS databases remain an opportunity for planning and strategic decisions. General objective: To collaboratively build the architecture of a decision-making algorithm for the implementation of clinical pharmacy services in oncology within the Brazilian Unified Health System (SUS). Method: Applied research, of a methodological nature, structured in three stages: a) theoretical (documentary analysis and scope review); b) theoretical-empirical (regulatory analysis and preliminary algorithm design); c) collaborative empirical (evaluation with oncology specialist pharmacists). Additionally, the project integrated the Technological Initiation Program (PIT/EBSERH nº02/2025), with a scholarship recipient dedicated to the inventory of DATASUS systems, the use of generative AI (DeepSeek®), and the development of the OncoFarmaSUS prototype. Results: The work was organized into scientific articles and technical-technological products. These included: a case study on hospital pharmaceutical management; a scoping review highlighting a gap in algorithms adapted to the Brazilian Unified Health System (SUS); collaborative construction of the algorithm architecture and validation of the layout and content by experts (agreement rate = 100%); an opinion article on public policies in the pharmaceutical area; and validation of the algorithm architecture in simulated scenarios, demonstrating its operability. The resulting technical-technological product was the architecture of an expert system (symbolic AI) composed of 8 attributes (Oncological Care, Pharmacist Team, Protocols, Humanized Follow-up, Pharmacovigilance, Dispensing and Costs, Teaching and Research, Patient-Centered Care) and 36 inference mechanisms, based on the author's professional experience and on Ordinance GM/MS No. 8,477/2025 (AF-Onco). From this, the navigable prototype of the OncoFarmaSUS application was developed, with a software registration request currently being processed by EBSERH/INPI. Originality and relevance: This research proposes an expert system focused on decision-making regarding the implementation of clinical pharmacy in oncology within the Brazilian Unified Health System (SUS), innovating in the following dimensions: technological (interoperability with DATASUS), methodological (integration between documentary research, generative AI, and prototyping), institutional (articulation between professional master's programs, technological initiation programs, and teaching hospitals), and social (improvement of public management, access to healthcare, and safety of cancer patients). Practical contributions and impact: For the teaching hospital, the results offered a readiness diagnostic tool aligned with AF-Onco; for the HU Brasil network, a replicable model; for public management, the innovative use of government data with application in direct patient care; and for training, it allows integration between postgraduate, undergraduate, and practice settings. Attached institutional statements attest to the hospital's interest in future implementation phases. Final considerations: The dissertation fulfilled its proposed objective, progressing from theoretical conception to functional prototyping and software registration. Integration with PIT/EBSERH enhanced the results and the training of human resources. Next steps include the implementation of the inference engine, effective integration with DATASUS, and pilot testing. OncoFarmaSUS embodies the integration between academic research, technological innovation, and public service practice scenarios, contributing to the strengthening of the SUS (Brazilian Unified Health System) and the improvement of oncological pharmaceutical care in Brazil. Tipo: Dissertação 2026-06-10T00:00:00Z http://bdtd.uftm.edu.br/handle/123456789/2142 Título: Práticas de governança e inovações para o enfrentamento da resistência antimicrobiana em hospital público de ensino Abstract: Objective: To develop an empirical theoretical model of governance practices and innovations to address antimicrobial resistance in a public teaching hospital. Theoretical basis: Tackling antimicrobial resistance is a global public policy concern. A worsening of the situation has been observed as a result of the Covid-19 pandemic. In addition to infection control challenges, the ability of public teaching hospitals to respond in their governance system has been questioned. Methodology: This is the elaboration of an empirical theoretical model resulting from the triangulation of the findings of an action research conducted by Convergent Care Research. A hospital documentary analysis of public governance practices in tackling antimicrobial resistance in a teaching hospital of the single health system was carried out between March and April/23. A scoping review was conducted according to the international PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol with the following question: 'What strategic innovations are being implemented in the management of AMR in teaching hospitals', using the databases Lilacs, PubMed, Cochrane Library, Embase, Web Of Science and Scopus, carried out in March/23. In addition, semi-structured interviews using a qualitative approach following contextualised content analysis were conducted with hospital stakeholders, characterised by 13 leaders working in mandatory and advisory hospital committees, between September and November 2023, asking: 'What are the challenges for hospital leadership in tackling antimicrobial resistance?' And: 'What are the prospects for innovation in hospital governance in tackling antimicrobial resistance?' Results: Document analysis: Results A total of 1,567 documents were analysed, 86 of which contained content related to the fight against antimicrobial resistance.We found that the Hospital de Clínicas da Universidade do Triângulo Mineiro uses governance practices to combat AR. Scoping review: the research resulted in a final sample of 17 articles published in indexed health journals that can support the dissemination and uptake of innovations in the management of antimicrobial resistance in teaching hospitals and have an impact on the better development of local, national and global policies, contributing to the policy agenda for tackling antimicrobial resistance. Semi-structured interviews: resulted in broad stakeholder engagement The following were highlighted: a) Challenges: promoting strategic management involving dialogue within and outside the public teaching hospital; developing the hospital's health teams to promote leadership in tackling antimicrobial resistance; and innovation in processes, routines and products in the face of risk management for the sustainability of the institution. B) Innovations: evidence-based decision making in the service; use of research in practice; antimicrobial stewardship; development of healthcare teams; patient-centred and timely care. In this way, the triangulation of findings supported the construction of the theoretical model, which has as its inputs (strategic management; internal and extramural dialogic management; leadership development; training of health care teams; innovations; risk management and economic sustainability; evidence-based decision-making in the service; use of research in practice; antimicrobial stewardship; development of health care teams; patient-centred and timely care); institutional plan/strategic master plan; institutional committees for prescription control; quality indicators; timely diagnostic detection; information technology; professional education and training; reinforcement of precautions; cleaning and disinfection), outputs (practices related to responsiveness, evidence-based practices and innovations, and hospital practices and routines) and controls (overall infection rate and clean surgery, ICU wound density and adult ICU antimicrobial resistance profile) Originality and Relevance: There are important gaps in the governance of public teaching hospitals, particularly in the integrated health system. The development of the theoretical-empirical model made it possible to identify important aspects of hospital governance in a real context The results of this dissertation, in terms of originality, are organised into a published scientific article on innovations in the management of antimicrobial resistance and a technical scientific report describing the action research (convergent care research) that culminated in the development of the theoretical-empirical model. Practical contributions: The important potential of this research was that the combination of methods made it possible to understand the local context and its relevance to the current global challenges of antimicrobial resistance. It also allowed local leaders (stakeholders) to present their perspectives - so that the model was built closer to the real scenario than the ideal - a contextualised model By getting closer to the scenario, it was possible to identify expanded practices and innovations in hospital governance In general, the content analysed contributes to guiding local hospital response capacity and potentially to aligning the network of teaching hospitals in the Unified Health System in terms of their governance challenges Thus, it contributes to strengthening the political agenda, global and local greements in the face of this growing global health threat. Tipo: Dissertação 2024-12-12T00:00:00Z http://bdtd.uftm.edu.br/handle/123456789/2106 Título: Conciliação na administração pública como instrumento de prevenção da execução fiscal Abstract: Tax enforcement is the legal action brought by the Union, States, Federal District, Municipalities and their respective autonomous entities to collect tax or non-tax credits registered as outstanding debt by the competent public body. These actions represent a significant portion of the cases pending in the judiciary and, for this reason, and given the need to obtain concrete diagnoses on the subject, the National Council of Justice (CNJ), in July 2011, conducted a survey, carried out by the Institute for Applied Economic Research (IPEA), which showed that, at the time, each tax enforcement action cost, on average, R$4,685.39 (four thousand six hundred and eighty-five reais and thirty-nine cents) to public coffers. Years later, the STF's Center for Structural and Complex Processes prepared Technical Notes No. 06/2023 and 08/2023, indicating that the minimum cost of a tax enforcement proceeding, considering only labor, is R$ 9,277.00 (nine thousand, two hundred and seventy-seven reais). Based on these Technical Notes, the Plenary of the Supreme Federal Court, when judging Extraordinary Appeal (RE) No. 1,355,208, on December 19, 2023 (Topic 1,184), established the thesis of the absence of standing to sue in low-value tax enforcement proceedings, based on the principle of administrative efficiency and the average cost of the process. In line with this understanding, the CNJ (National Council of Justice) issued Resolution No. 547, which establishes measures for the rational and efficient handling of pending tax enforcement proceedings in the Judiciary, in line with the Supreme Federal Court's (STF) ruling on General Repercussion Theme 1184. Given this scenario, this research starts from the following question: how to implement an administrative conciliation policy that prevents the unnecessary filing of tax enforcement proceedings and optimizes the recovery of public credit? Thus, this study aims to analyze administrative conciliation as an alternative to the judicialization of outstanding debt. Inserted within the Public Administration and Organizations research line of the PROFIAP Network, this work contributes to the formulation and implementation of sustainable management practices and organizational strategies in the public sector. This is a qualitative research study with a descriptive approach, which uses documentary and normative sources, associated with the analysis of data obtained from the PJe and SIJUD systems, referring to the period from 2022 to 2025. The results show that a large part of the filed tax enforcement proceedings have values lower than the minimum estimated cost for their processing, which characterizes an uneconomical model of judicial collection. Based on this diagnosis, the work proposes procedural guidelines for the implementation of a tax conciliation policy, in accordance with the principles of legality, efficiency and unavailability of public credit. The originality of the research lies in the articulation between legal foundations, local data and the proposition of a practical solution, adapted to the municipal reality. The impact of the study is potential and organizational, with the possibility of replication in other municipalities of similar size and facing similar challenges, contributing to the rationalization of public spending, the strengthening of extrajudicial collection, the modernization of fiscal management in the public sector and compliance with the guidelines of the Supreme Federal Court and the National Council of Justice. Tipo: Dissertação 2026-03-10T00:00:00Z http://bdtd.uftm.edu.br/handle/123456789/2105 Título: Construção e validação de Banco de Itens para formalização de convênios e instrumentos congêneres entre a Rede PROFIAP e usuários do conhecimento Abstract: Introduction: There is a triadic relationship in contemporary times that increasingly aims to integrate universities, industry, and government, so that scientific research can be proactive in responding to today's complex social demands. This collaboration highlights the power of innovation that arises from the connection between these three elements. The challenges in establishing partnerships between educational and research institutions and society are common in different locations worldwide. Research Problem: A gap was observed based on a scoping review linked to this research, as it returned only three studies directly related to the subject, published prior to the new Bidding and Contracts Law taking effect. This highlights the need for further studies on the topic, requiring more in-depth investigations into the scope of partnerships, key development needs, and potential internal impasses within institutions. Study Question: How can we address sensitive points and opportunities for improvement in establishing agreements and similar instruments between the PROFIAP Network and knowledge users? Objectives: To construct and validate an item bank to identify sensitive points and opportunities for improvement in the establishment of agreements and similar instruments between the PROFIAP Network and knowledge users. Method: Methodological study of item bank construction and validation, guided by theoretical and empirical phases: definition of a problem and content ideas; establishment of the conceptual framework and purpose of the construct; construction of the items themselves and structuring of the content and its operationalization; and content validation by a Committee of Experts, according to Pasquali's theoretical framework (Theory of Instrumental Elaboration). Setting and study population: The study was conducted within the Professional Master's Network in Public Administration (PROFIAP), composed of 40 Associated Universities, whose target population is assigned to the respective Coordinators (1st stage) and Coordinators with experience in the topic (2nd stage). The questionnaire was administered digitally in both stages of the research. Analytical Proposal: The first stage involved a systematic and objective analysis of the content of a dataset to understand its meaning and identify patterns or trends, supported by Artificial Intelligence Natural Language Processing (ChatGPT®). The second stage involved content validation by a Committee of Expert Judges based on the following aspects: validity, clarity, practicality, relevance, and interpretability. The evaluation will be conducted using a four-point Likert scale, followed by a Content Validity Index (CVI) score. Ethical Aspects: In compliance with the standards of the National Council for Ethics in Research involving Human Beings, the Research Ethics Committee of the Hospital de Clínicas of UFTM (Federal University of São Paulo) approved the Research Project on April 8, 2025. Achieved Results: The present research resulted in a scientific article, using a qualitative approach, through the application of a digital questionnaire to coordinators and vice-coordinators of the 40 institutions associated with the PROFIAP Network, with the participation of 17 respondents. The analysis of the responses allowed the identification of central categories related to institutional structure and support, bureaucracy and legal security, alignment of interests, communication and articulation, as well as evaluation and transparency. The results highlighted weaknesses, such as inequality between centers, the absence of agreements in most institutions, and the low experience of the coordinators in formalizing partnerships. As a second result, a scientific article is presented on the construction and validation of the Item Bank, through validation by a Committee composed of four previously selected Expert Judges, based on their experience in the subject, as a subsidy for the entire interaction process. The Item Bank was structured and validated in four key elements: Opportunities; Thematic Areas; Potential Actions; and Actors and Competencies. Finally, the Concluding Technical Report was prepared as the Technical-Technological Product (PTT) of the scientific research, and filed with the General Coordination of PROFIAP. Tipo: Dissertação 2025-12-10T00:00:00Z