A gestão de tesouraria nas instituições de Ensino Superior

No atual contexto económico e financeiro, a gestão de tesouraria assume uma importância relevante dentro das organizações. Efetivamente, o dinheiro é a preocupação de qualquer gestor. A obtenção deste recurso escasso, com o mínimo custo e geri-lo de forma a otimizá-lo, é sem dúvida, o objetivo de qualquer gestor financeiro, no contexto de incerteza em que nos movemos. A atual crise proporciona à tesouraria a oportunidade ideal de realçar a sua importância estratégica e o valor acrescentado que pode trazer às organizações. Todas as áreas da organização, direta ou indiretamente, mantêm ligações com a área de tesouraria. O objetivo deste trabalho é enfatizar a relevância da gestão de tesouraria nos processos financeiros, antecipando informações para análise e tomada de decisão dos responsáveis financeiros nas Instituições de Ensino Superior; é demonstrar que a gestão de tesouraria deve fazer parte da cultura da organização e que é uma ferramenta de apoio para o planeamento financeiro, da gestão estratégica, de investimentos e de aproveitamento de oportunidades de crescimento das Instituições de Ensino Superior. Por último, pretendeu-se identificar e sugerir boas práticas e melhorias nos processos existentes, nas Instituições de Ensino Superior, que possam contribuir para a eficiência e eficácia da gestão de tesouraria. A revisão da literatura conduziu-nos à análise das diversas perspetivas da gestão de tesouraria, a importância das boas práticas, do sistema de controlo interno e da auditoria. Mostrou-se pertinente compreender o contexto jurídico das IES. Foi relevante a abordagem dos ciclos financeiros das organizações, para compreender a importância da realização de orçamentos de tesouraria, como um instrumento do controlo dos fluxos financeiros e da tomada de decisões dentro das organizações. Realizou-se ainda uma abordagem à gestão de crédito, às fontes de financiamento e à temática da centralização da gestão de tesouraria nas IES, por se entender que são aspetos fundamentais que contribuem para a eficiência e a eficácia desta área de atuação das instituições. Decorrente da revisão da literatura, identificaram-se as perguntas de investigação e aplicou-se a metodologia de um estudo de caso único de uma instituição de ensino superior, através da elaboração de entrevistas, recolha dos dados, pesquisa documental, observação direta e participativa do investigador. As conclusões finais do nosso estudo revelaram que o modelo de análise aplicado ao IPP, teve uma taxa de confirmação de 53%. As componentes do modelo em análise com os resultados mais significativos e que mais contribuíram para esta confirmação, foram a gestão de tesouraria considerada como um patamar estratégico nesta IES, a elaboração do orçamento de tesouraria e os procedimentos associados ao sistema de controlo interno.

A eficácia dos contratos-programa no setor público da saúde na região Norte de Portugal

Em Portugal o sistema de saúde assume uma importante função no desenvolvimento económico e social, na medida em que os serviços prestados pelo mesmo influenciam não só o bem-estar social como também a produtividade. O processo de contratualização alia-se ao setor público da saúde através do contrato-programa, o qual pretende estabelecer uma estratégia a seguir. O presente trabalho pretende verificar se o setor público da saúde respeita os princípios de economia, eficiência e eficácia, de um modo geral, pretende-se perceber se os contratos-programa são cumpridos na sua totalidade. Para tal procedeu-se à recolha da informação descrita nos relatórios de gestão dos quinze Hospitais que pertencem à Administração Regional de Saúde do Norte. A incerteza relacionada com os contratos-programa, a não existência de um modelo linear para a divulgação pública dos resultados no âmbito do contrato-programa, e ainda o facto de a totalidade das entidades não ser obrigada a emitir essa publicação, conduz à possibilidade de que não estejam a ser cumpridos os princípios da economia, eficácia e eficiência.

Phototherapy in Childhood: a 17-Year Retrospective Study Regarding Effectiveness and Safety

Introduction: Skin diseases in paediatric age are often distressing conditions with significant impact in children’s psychosocial development. Additionally, systemic therapeutic options are often limited in childhood, due to its potential toxicity in this vulnerable group. Phototherapy is therefore an endorsed option for photo-responsive dermatological conditions. Objective and Methods:This observational retrospective study aims to access efficacy and safety of Phototherapy in our paediatric population. Relevant clinical data from 1996 to present concerning patients aged 18 years or less was collected. Results: 78 patients were included, of which64,1%was female. Mean age was 12,9 years (range 2-18). Distribution according to diagnosis was:47,4%psoriasis, 34,6% alopecia areata, 9,0% vitiligo, 9,0% other diagnosis. Mean number of cycles was 1,5 (range 1-7), with an average of 16,3 treatments per cycle and mean cumulative dose 134 J/cm2. 70,5% was treated with one single cycle. Topic and systemic PUVA were the first choice in 37,2% and 39,7%, respectively, while UVB TL01 and broadband UVB were used in 11,5% each. On the first cycle 67,5% improved, 14,3% showed no sustained clinical response and 19,5% were lost to follow-up. Psoriasis patients had the best response rates (81,8%), followed by alopecia areata (59,3%). Side effects occurred in 21%, being erythema the most common (12%). None led to therapeutic interruption. Discussion: Phototherapy is a safe and effective option in childhood, yet the withdraw rate might be an important limitation.

Safety and Effectiveness of the Genous™ Endothelial Progenitor Cell-Capture Stent in the First Year Following ST-Elevation Acute Myocardial Infarction: A Single Center Experience and Review of the Literature

PURPOSE: The Genous™ stent (GS) is designed to accelerate endothelization, which is potentially useful in the pro-thrombotic environment of ST-elevation acute myocardial infarction (STEMI). We aimed to evaluate the safety and effectiveness of the GS in the first year following primary percutaneous coronary intervention (PCI) and to compare our results with the few previously published studies. METHODS AND MATERIALS: All patients admitted to a single center due to STEMI that underwent primary PCI using exclusively GS, between May 2006 and January 2012, were enrolled. The primary study endpoints were major adverse cardiac events (MACEs), defined as the composite of cardiac death, acute myocardial infarction and target vessel revascularization, at one and 12months. RESULTS: In the cohort of 109 patients (73.4% male, 59 ±12years), 24.8% were diabetic. PCI was performed in 116 lesions with angiographic success in 99.1%, using 148 GS with median diameter of 3.00mm (2.50-4.00) and median length of 15mm (9-33). Cumulative MACEs were 2.8% at one month and 6.4% at 12months. Three stent thromboses (2.8%), all subacute, and one stent restenosis (0.9%) occurred. These accounted for the four target vessel revascularizations (3.7%). At 12months, 33.9% of patients were not on dual antiplatelet therapy. CONCLUSIONS: GS was safe and effective in the first year following primary PCI in STEMI, with an apparently safer profile comparing with the previously published data. SUMMARY: We report the safety and effectiveness of the Genous™ stent (GS) in the first year following primary percutaneous coronary intervention in ST-elevation acute myocardial infarction. A comprehensive review of the few studies that have been published on this subject was included and some suggest a less safe profile of the GS. Our results and the critical review included may add information and reinforce the safety and effectiveness of the GS in ST-elevation in acute myocardial infarction.

Safety and Effectiveness of the Genous Endothelial Progenitor Cell-Capture Stent: Follow-Up to 5 Years

AIMS: To evaluate the long-term clinical outcomes following percutaneous coronary intervention (PCI) with the Genous stent in an unselected population. METHODS: All patients admitted to a single center who underwent PCI using the GS exclusively, between May 2006 and May 2012, were enrolled, and a clinical follow-up of up to 60 months was carried out. The primary endpoint of major adverse cardiac event (MACE) rate was defined as the composite of cardiac death, acute myocardial infarction (AMI), and target lesion revascularization (TLR). RESULTS: Of the 450 patients included (75.1% male; 65.5 ± 11.7 years), 28.4% were diabetic and acute coronary syndrome was the reason for PCI in 76.4%. Angioplasty was performed in 524 lesions using 597 Genous stents, with angiographic success in 97.1%. At a median of 36 months of follow-up (range, 1-75 months), MACE, AMI, TLR, stent restenosis (SR), and stent thrombosis (ST) rates were 15.6%, 8.4%, 4.4%, 3.8%, and 2.2%, respectively. Between 12 and 24 months, the TLR, SR, and ST rates practically stabilized, up to 60 months. Bifurcation lesions were independently associated with MACE, TLR, and SR. CONCLUSION: This is the first study reporting clinical results with the Genous stent up to 60 months. The Genous stent was safe and effective in the long-term, in an unselected population.

Navegação web anónima e segura

A Web aproximou a humanidade dos seus pares a um nível nunca antes visto. Com esta facilidade veio também o cibercrime, o terrorismo e outros fenómenos característicos de uma sociedade tecnológica, plenamente informatizada e onde as fronteiras terrestres pouco importam na limitação dos agentes ativos, nocivos ou não, deste sistema. Recentemente descobriu-se que as grandes nações “vigiam” atentamente os seus cidadãos, desrespeitando qualquer limite moral e tecnológico, podendo escutar conversas telefónicas, monitorizar o envio e receção de e-mails, monitorizar o tráfego Web do cidadão através de poderosíssimos programas de monitorização e vigilância. Noutros cantos do globo, nações em tumulto ou envoltas num manto da censura perseguem os cidadãos negando-lhes o acesso à Web. Mais mundanamente, há pessoas que coagem e invadem a privacidade de conhecidos e familiares, vasculhando todos os cantos dos seus computadores e hábitos de navegação. Neste sentido, após o estudo das tecnologias que permitem a vigilância constante dos utilizadores da Web, foram analisadas soluções que permitem conceder algum anónimato e segurança no tráfego Web. Para suportar o presente estudo, foi efetuada uma análise das plataformas que permitem uma navegação anónima e segura e um estudo das tecnologias e programas com potencial de violação de privacidade e intrusão informática usados por nações de grande notoriedade. Este trabalho teve como objetivo principal analisar as tecnologias de monitorização e de vigilância informática identificando as tecnologias disponíveis, procurando encontrar potenciais soluções no sentido de investigar a possibilidade de desenvolver e disponibilizar uma ferramenta multimédia alicerçada em Linux e em LiveDVD (Sistema Operativo Linux que corre a partir do DVD sem necessidade de instalação). Foram integrados recursos no protótipo com o intuito de proporcionar ao utilizador uma forma ágil e leiga para navegar na Web de forma segura e anónima, a partir de um sistema operativo (SO) virtualizado e previamente ajustado para o âmbito anteriormente descrito. O protótipo foi testado e avaliado por um conjunto de cidadãos no sentido de aferir o seu potencial. Termina-se o documento com as conclusões e o trabalho a desenvolver futuramente.

Application of ionic liquids and enzymes for the removal of proteinaceous layers from polychrome of works of art and evaluation of the cleaning effectiveness

Dissertação Apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Ciências da Conservação, especialização em Pintura

Levonorgestrel Intrauterine Device Effectiveness in Heavy Menstrual Bleeding Treatment in Obese Women

Objective:We aimed to identify if there was any difference in Levonorgestrel-releasing intrauterine system (LNG-IUS) efficacy or weight gain when used in heavy menstrual bleeding (HMB) treatment, between obese and non-obese women. Population and methods: This was a case-controlled retrospective study undertaken between 2002-2007. 194 women with HMB were treated with LNG-IUS and stratified into two groups accordingly with body mass index (BMI): Obese Group – BMI ≥ 30 (n=53) and Non-obese Group – BMI < 30 (n=141). Age, weight, days of spotting and days of menses were analyzed at 1, 3 and 6 months after insertion and then annually until 2 years. Analytic parameters of anemia (hemoglobin, serum ferritin, mean corpuscular volume) were reviewed at pre-insertion, at 6 months and then annually until 2 years. Results: During the 2-year follow-up there was a similar improvement in two groups regarding duration of menses, spotting and in analytic parameters of anemia. A statistically significant improvement was observed in obese group after 2 years of treatment regarding analytic parameters of anemia and menstrual characteristics, without weight gain. Conclusion: In obese women, the LNG-IUS is an effective treatment for heavy menstrual bleeding, without being associated to weight gain.

A Pilot Cost-Effectiveness Analysis of Treatments in Newly Diagnosed High-Grade Gliomas: The Example of 5-Aminolevulinic Acid Compared With White-Light Surgery

BACKGROUND: High-grade gliomas are aggressive, incurable tumors characterized by extensive diffuse invasion of the normal brain parenchyma. Novel therapies at best prolong survival; their costs are formidable and benefit is marginal. Economic restrictions thus require knowledge of the cost-effectiveness of treatments. Here, we show the cost-effectiveness of enhanced resections in malignant glioma surgery using a well-characterized tool for intraoperative tumor visualization, 5-aminolevulinic acid (5-ALA). OBJECTIVE: To evaluate the cost-effectiveness of 5-ALA fluorescence-guided neurosurgery compared with white-light surgery in adult patients with newly diagnosed high-grade glioma, adopting the perspective of the Portuguese National Health Service. METHODS: We used a Markov model (cohort simulation). Transition probabilities were estimated with the use of data from 1 randomized clinical trial and 1 noninterventional prospective study. Utility values and resource use were obtained from published literature and expert opinion. Unit costs were taken from official Portuguese reimbursement lists (2012 values). The health outcomes considered were quality-adjusted life-years, lifeyears, and progression-free life-years. Extensive 1-way and probabilistic sensitivity analyses were performed. RESULTS: The incremental cost-effectiveness ratios are below €10 000 in all evaluated outcomes, being around €9100 per quality-adjusted life-year gained, €6700 per life-year gained, and €8800 per progression-free life-year gained. The probability of 5-ALA fluorescence-guided surgery cost-effectiveness at a threshold of €20000 is 96.0% for quality-adjusted life-year, 99.6% for life-year, and 98.8% for progression-free life-year. CONCLUSION: 5-ALA fluorescence-guided surgery appears to be cost-effective in newly diagnosed high-grade gliomas compared with white-light surgery. This example demonstrates cost-effectiveness analyses for malignant glioma surgery to be feasible on the basis of existing data.

Cost-Effectiveness of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation in Portugal

INTRODUCTION AND OBJECTIVES:Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. METHODS: A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). RESULTS:Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. CONCLUSIONS:Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.

Lights and Shadows about the Effectiveness of IVF in HIV Infected Women: A Systematic Review

Background. HIV infected women have higher rates of infertility. Objective. The purpose of this literature review is to evaluate the effectiveness of fresh IVF/ICSI cycles in HIV infected women. Materials and Methods. A search of the PubMed database was performed to identify studies assessing fresh nondonor oocyte IVF/ICSI cycle outcomes of serodiscordant couples with an HIV infected female partner. Results and Discussion. Ten studies met the inclusion criteria. Whenever a comparison with a control group was available, with the exception of one case, ovarian stimulation cancelation rate was higher and pregnancy rate (PR) was lower in HIV infected women. However, statistically significant differences in both rates were only seen in one and two studies, respectively. A number of noncontrolled sources of bias for IVF outcome were identified. This fact, added to the small size of samples studied and heterogeneity in study design and methodology, still hampers the performance of a meta-analysis on the issue. Conclusion. Prospective matched case-control studies are necessary for the understanding of the specific effects of HIV infection on ovarian response and ART outcome.

Effectiveness of the Dexamethasone Intravitreal Implant for Treatment of Patients with Diabetic Macular Oedema

Diabetic macular oedema (DMO) is a leading cause of vision loss in the working-age population worldwide. Corticosteroid drugs have been demonstrated to inhibit the expression of both the vascular endothelial growth factor (VEGF) gene and other anti-inflammatory mediators, such as prostaglandins. Triamcinolone, fluocinolone and dexamethasone are the main steroids that have been studied for the treatment of macular oedema. Over the last few years, several studies have suggested an important role for dexamethasone in the management of DMO. The dexamethasone intravitreal implant (DEX implant) (Ozurdex®; Allergan, Inc., Irvine, CA) is a novel approach approved by the US Food and Drug Administration (FDA) and by the EU for the intravitreal treatment of macular oedema after branch or central retinal vein occlusion, and for the treatment of non-infectious uveitis affecting the posterior segment of the eye. We reviewed manuscripts that had investigated the pharmacokinetics, efficacy and safety of the DEX implant regarding DMO treatment.

Different in Vivo Reactivity Profile in Health Care Workers and Patients with Spina Bifida to Internal and External Latex Glove Surface-Derived Allergen Extracts

BACKGROUND: Allergy to natural rubber latex is a well-recognized health problem, especially among health care workers and patients with spina bifida. Despite latex sensitization being acquired in health institutions in both health care workers and patients with spina bifida, differences in allergen sensitization profiles have been described between these two risk groups. OBJECTIVE: To investigate the in vivo reactivity of health care workers and patients with spina bifida to extracts of internal and external surfaces of latex gloves and also to specific extracts enriched in major allergens for these risk groups. METHODS: Gloves from different manufacturers were used for protein extraction, and salt precipitation and hydrophobic interaction chromatography (HIC) were applied to obtain the enriched latex extracts. The major latex allergens were quantified by an enzyme immunoassay. The extracts obtained were tested in 14 volunteers using skin prick tests (SPT). RESULTS: Latex glove extracts enriched in the hydrophobic allergens that are most often seen in patients with spina bifida were obtained by selective precipitation, whereas HIC produced extracts enriched in the hydrophilic allergens commonly found in health care workers. The health care workers had positive SPTs to glove extracts from internal surfaces and to the hydrophilic allergen-enriched extracts. By contrast, patients with spina bifida had larger skin reactions both to external glove extracts and to the extracts enriched with the hydrophobic major allergens for this risk group. Despite the protein concentration of these extracts being less than half the concentration of the commercial extract, the weal-and-flare reactions were of similar magnitude. CONCLUSION: Using novel latex extracts, our study showed a different in vivo reactivity pattern in health care workers and in patients with spina bifida to extracts of the internal and external surfaces of gloves, which suggests that sensitization may occur by different routes of exposure, and that this influences the allergen reactivity profiles of these risk groups

Balanced scorecard como metodologia utilizada no planeamento estratégico de um laboratório de patologia clínica

RESUMO - O título do presente trabalho de projeto é: “Balanced Scorecard como metodologia utilizada no planeamento estratégico de um Laboratório de Patologia Clínica”. Atualmente a qualidade dos serviços prestados na área da saúde constitui uma questão que preocupa todos os stakeholders envolvidos. Neste âmbito, a escolha desta temática prende-se com a necessidade urgente de mudança no sentido de melhorar a performance do Laboratório de Patologia Clínica. Melhorar a qualidade dos serviços prestados garantindo a eficiência e sustentabilidade do serviço constitui a grande máxima de qualquer organização. Os objetivos deste trabalho de projeto são, entre outros: analisar as implicações da avaliação da qualidade de gestão utilizando o Balanced Scorecard como metodologia; destacar a importância do uso desta metodologia num Laboratório de Patologia Clínica no que diz respeito à melhoria da qualidade, da efetividade e da eficiência e apresentar uma proposta de aplicação desta metodologia a um serviço de Patologia Clínica. A filosofia do Balanced Scorecard assenta em 4 perspetivas, financeira, dos clientes, dos processos internos e a perspetiva crescimento e aprendizagem, que funcionam de forma integrada permitindo uma avaliação da qualidade de gestão. Em cada uma destas perspetivas são definidos objetivos e indicadores que têm de funcionar de forma integrada estabelecendo relações causa-efeito entre elas. Qualquer falha decorrente de objetivos não atingidos numa das perspetivas origina o desequilíbrio de todo o sistema desencadeando desvios no percurso estratégico, no cumprimento da missão e da visão da organização. A metodologia utilizada consiste essencialmente na recolha de dados resultantes da entrevista, pesquisa bibliográfica e análise documental do serviço de Patologia Clínica, que contribuíram para a elaboração de uma proposta de implementação. A aplicação de um sistema de medição da qualidade é essencial e a metodologia Balanced Scorecard pode constituir uma ferramenta fundamental neste sentido, facilitando a gestão de organizações de saúde.

Effectiveness of online marketing tools

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics