Discrepancies between clinical diagnoses and autopsy findings

Autopsy examination is considered to be an essential element for medical auditing and teaching. Despite the significant progress in diagnostic procedures, autopsy has not always confirmed the clinical diagnosis. In the present study, we compared the diagnosis recorded on medical charts with reports of 96 autopsies performed at the University Teaching Hospital of the Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil, between 1975 and 1982, and of 156 autopsies performed at the same institution between 1992 and 1996. The clinical diagnosis of the basic cause of death was confirmed at autopsy in 77% of cases. The percent confirmation fell to 60% when the immediate terminal cause of death was considered, and in 25% of cases, the terminal cause was only diagnosed at autopsy. The discrepancies between clinical and autopsy diagnosis were even larger for secondary diagnoses: 50% of them were not suspected upon clinical diagnosis. Among them, we emphasize the diagnosis of venous thromboses (83%), pulmonary embolisms (80%), bronchopneumonias (46%) and neoplasias (38%). Iatrogenic injuries were very frequent, and approximately 90% of them were not described in clinical reports. Our results suggest that highly sensitive and specific diagnostic tests are necessary but cannot substitute the clinical practice for the elaboration of correct diagnoses.

Auditoria no Sistema Único de Saúde: o papel do auditor no serviço odontológico

A auditoria, na saúde, verifica os processos e resultados da prestação de serviços, pressupondo o desenvolvimento de um modelo de atenção adequado, de acordo com as legislações vigentes. Nesta pesquisa, objetivou-se analisar as atividades da auditoria no Sistema Único de Saúde no serviço de saúde bucal, buscando demonstrar as ações e a sua inserção nas três esferas de governo. Foram realizadas análise documental e levantamentos bibliográficos sobre os sistemas de auditoria e o papel do auditor no serviço odontológico desde 1969. Os resultados mostraram que foram encontrados seis artigos sobre auditoria odontológica no SUS e que a atuação do auditor odontológico é abrangente no gerenciamento do sistema, consistindo no controle, na avaliação, na supervisão e na orientação, bem como na garantia da participação social e acesso aos serviços. Na saúde bucal o auditor analisa, monitora e fiscaliza o planejamento das estratégias e os procedimentos efetuados; realiza o cadastramento dos profissionais, das unidades de saúde e a programação física orçamentária; viabiliza os dados para o sistema de informação e o pagamento dos serviços prestados; examina o cumprimento das pactuações, dando um enfoque educativo e não mais policialesco à resolubilidade dos problemas. Conclui-se que existem poucos estudos sobre auditoria odontológica no SUS e que o sistema de auditoria é um instrumento administrativo confiável e essencial para os gestores no desenvolvimento das ações de saúde.

Selecting green suppliers based on GSCM practices: Using fuzzy TOPSIS applied to a Brazilian electronics company

Due to an increased awareness and significant environmental pressures from various stakeholders, companies have begun to realize the significance of incorporating green practices into their daily activities. This paper proposes a framework using Fuzzy TOPSIS to select green suppliers for a Brazilian electronics company; our framework is built on the criteria of green supply chain management (GSCM) practices. An empirical analysis is made, and the data are collected from a set of 12 available suppliers. We use a fuzzy TOPSIS approach to rank the suppliers, and the results of the proposed framework are compared with the ranks obtained by both the geometric mean and the graded mean methods of fuzzy TOPSIS methodology. Then a Spearman rank correlation coefficient is used to find the statistical difference between the ranks obtained by the three methods. Finally, a sensitivity analysis has been performed to examine the influence of the preferences given by the decision makers for the chosen GSCM practices on the selection of green suppliers. Results indicate that the four dominant criteria are Commitment of senior management to GSCM; Product designs that reduce, reuse, recycle, or reclaim materials, components, or energy; Compliance with legal environmental requirements and auditing programs; and Product designs that avoid or reduce toxic or hazardous material use. © 2013 Elsevier B.V. All rights reserved.

Sistema de auditoria no SUS: análise dos dados de produção e glosas no serviço odontológico na rede pública

Pós-graduação em Odontologia Preventiva e Social - FOA

Cleaner Production initiatives and challenges for a sustainable world: an introduction to this special volume

This special volume of the Journal of Cleaner Production is comprised of articles presented at the 3rd International Workshop Advances in Cleaner Production held in Sao Paulo, Brazil, in 2011. The content underscores the recognition of the pressing and inescapable need for making changes from unsustainable to sustainable production and consumption patterns. The 48 articles from 15 countries provide different, but complimentary approaches to help industrial and societal sectors in advancing on their paths towards sustainability. Initiatives and challenges are included, which systematically address problems affecting raw material changes, technological modifications, product and policy changes. The findings range from proposals for alternative uses of wastes, substitution of raw materials for environmentally friendlier substances, optimization of industrial processes by source reductions of wastes and emissions and documented economic and environmental advantages of a wide array of initiatives. The roles of operational and managerial practices are also stressed, highlighting the role of diverse stakeholders as promoters of implementation and internalization of innovative cleaner technologies within companies. Systemic assessment tools are employed and experimented with in order to more effectively evaluate the environmental performance of systems on the biosphere scale. The methodological procedures and proposals presented can help in the design and management of production systems, for governmental and corporate policy development, for implementing and monitoring CP Programs, prevention and mitigation strategies, and evaluation of the outcomes of CP initiatives in the production and service sectors. (C) 2013 Elsevier Ltd. All rights reserved.

Evidências da relação entre evolução da gestão ambiental e a adoção de práticas de Green Supply Chain Management no setor eletroeletrônico brasileiro

The objective of this research is to examine if the environmental management evolution is positively related towards the adoption of green supply chain management practices (GSCM) by companies in the electronics sector in Brazil. To reach this objective, a quantitative research was conducted by survey with 100 companies in the electronics sector in Brazil. The collected data were processed using descriptive statistics, Exploratory Factor Analysis and Structural Equation Modeling. The most important results are: in the sample, GSCM practices to the recovery of investment, as the resale of scrap and other waste materials, and the adequacy with legislation and auditing, obtained high scores; and research hypothesis (H1) was confirmed and considered statistically valid, indicating that, in fact, the evolution of environmental management influences the adoption of GSCM practices.