Intra-hospital organ and tissue donation coordination project: cost-effectiveness and social benefits

OBJECTIVE To evaluate the viability of a professional specialist in intra-hospital committees of organ and tissue donation for transplantation. METHODS Epidemiological, retrospective and cross-sectional study (2003-2011 and 2008-2012), which was performed using organ donation for transplants data in the state of Sao Paulo, Southeastern Brazil. Nine hospitals were evaluated (hospitals 1 to 9). Logistic regression was used to evaluate the differences in the number of brain death referrals and actual donors (dependent variables) after the professional specialist started work (independent variable) at the intra-hospital committee of organ and tissue donation for transplantation. To evaluate the hospital invoicing, the hourly wage of the doctor and registered nurse, according to the legislation of the Consolidation of Labor Laws, were calculated, as were the investment return and the time elapsed to do so. RESULTS Following the nursing specialist commencement on the committee, brain death referrals and the number of actual donors increased at hospital 2 (4.17 and 1.52, respectively). At hospital 7, the number of actual donors also increased from 0.005 to 1.54. In addition, after the nurse started working, hospital revenues increased by 190.0% (ranging 40.0% to 1.955%). The monthly cost for the nurse working 20 hours was US$397.97 while the doctor would cost US$3,526.67. The return on investment was 275% over the short term (0.36 years). CONCLUSIONS This paper showed that including a professional specialist in intra-hospital committees for organ and tissue donation for transplantation proved to be cost-effective. Further economic research in the area could contribute to the efficient public policy implementation of this organ and tissue harvesting model.

Using remote labs in education: two little ducks in remote experimentation

A book about remote labs and engineering education begs to begin with the question, “Why do engineering programs include lab work?” Although this may seem like a given and not worth discussing, whenever we’re faced with innovative ideas, it’s important to “put everything on the table” in order to reassess its value to our program or goals. What is it about lab work that is of value to students? Are there elements of traditional labs that we could let go of? Are there elements that we don’t want to lose? These questions can help us to clarify how and why labs are integrated into an engineering education program.

Vulnerabilities in snakebites in Sao Paulo, Brazil

ABSTRACT OBJECTIVE To describe elements of vulnerability of victims of snakebite. METHODS This qualitative, descriptive, cross-sectional study had, as theoretical framework, the concept of vulnerability in individual, social, and programmatic dimensions. We interviewed 21 patients admitted into a hospital specialized in the care of accidents caused by venomous animals. The interviews were analyzed according to a discourse analysis technique. RESULTS Patients were mainly young men, living in remote countryside areas, where health services frequently have limited resources. We found social and individual conditions of vulnerability, such as precarious schooling, low professional qualification, housing without access to piped water, no sewage treated, and no regular garbage collection, and lack of knowledge on this health problem. Regarding the programmatic dimension, we found limited accessibility to the health services that could affect the prognosis and the frequency of sequelae and deaths. CONCLUSIONS Considering such vulnerabilities evoke the need to improve the program for control the Accidents by Venomous Animals and the training of health workers, we highlight the potential use of the concept of vulnerability, which may amplify the understanding and the recommendations for the practice and education related to snakebites.

Utilization of remote experimentation in mobile devices for education

In this paper the authors intend to demonstrate the utilization of remote experimentation (RE) using mobile computational devices in the Science areas of the elementary school, with the purpose to develop practices that will help in the assimilation process of the subjects taught in classroom seeking to interlink them with the daily students? activities. Allying mobility with RE we intend to minimize the space-temporal barrier giving more availability and speed in the information access. The implemented architecture utilizes technologies and freely distributed softwares with open code resources besides remote experiments developed in the Laboratory of Remote Experimentation (RExLab) of Federal University of Santa Catarina (UFSC), in Brazil, through the physical computation platform of the ?open hardware of construction of our own. The utilization of open code computational tools and the integration of hardware to the 3D virtual worlds, accessible through mobile devices, give to the project an innovative face with a high potential for reproducibility and reusability.

Impact of long-stay beds on the performance of a tertiary hospital in emergencies

ABSTRACT OBJECTIVE To assess the impact of implementing long-stay beds for patients of low complexity and high dependency in small hospitals on the performance of an emergency referral tertiary hospital. METHODS For this longitudinal study, we identified hospitals in three municipalities of a regional department of health covered by tertiary care that supplied 10 long-stay beds each. Patients were transferred to hospitals in those municipalities based on a specific protocol. The outcome of transferred patients was obtained by daily monitoring. Confounding factors were adjusted by Cox logistic and semiparametric regression. RESULTS Between September 1, 2013 and September 30, 2014, 97 patients were transferred, 72.1% male, with a mean age of 60.5 years (SD = 1.9), for which 108 transfers were performed. Of these patients, 41.7% died, 33.3% were discharged, 15.7% returned to tertiary care, and only 9.3% tertiary remained hospitalized until the end of the analysis period. We estimated the Charlson comorbidity index – 0 (n = 28 [25.9%]), 1 (n = 31 [56.5%]) and ≥ 2 (n = 19 [17.5%]) – the only variable that increased the chance of death or return to the tertiary hospital (Odds Ratio = 2.4; 95%CI 1.3;4.4). The length of stay in long-stay beds was 4,253 patient days, which would represent 607 patients at the tertiary hospital, considering the average hospital stay of seven days. The tertiary hospital increased the number of patients treated in 50.0% for Intensive Care, 66.0% for Neurology and 9.3% in total. Patients stayed in long-stay beds mainly in the first 30 (50.0%) and 60 (75.0%) days. CONCLUSIONS Implementing long-stay beds increased the number of patients treated in tertiary care, both in general and in system bottleneck areas such as Neurology and Intensive Care. The Charlson index of comorbidity is associated with the chance of patient death or return to tertiary care, even when adjusted for possible confounding factors.

Use of medicines recommended for secondary prevention of acute coronary syndrome

ABSTRACT OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.

WebLabs in education

Remote Labs are an emergent educational resource in Engineering, which addresses the remote delivery of practical contents, i. e. remote experiments, through the web. This resource may either be used as a support for e-learning courses in Engineering or Science, in the cases where on-campus lab work is not possible, or as a complement to face-to-face lab classes, allowing the students to repeat a given experiment on a remote fashion, without time restrictions.

Formative assessment and motivation in higher education: a successful approach in mechanical engineer thermodynamics

Between 2000/01 and 2006/07, the approval rate of a Thermodynamics course in a Mechanical Engineer graduation was 25%. However, a careful analysis of the results showed that 41% of the students chosen not to attend or dropped out, missing the final examination. Thus, a continuous assessment methodology was developed, whose purpose was to reduce drop out, motivating students to attend this course, believing that what was observed was due, not to the incapacity to pass, but to the anticipation of the inevitability of failure by the students. If, on one hand, motivation is defined as a broad construct pertaining to the conditions and processes that account for the arousal, direction, magnitude, and maintenance of effort, on the other hand, assessment is one of the most powerful tools to change the will that students have to learn, motivating them to learn in a quicker and permanent way. Some of the practices that were implemented, included: promoting learning goal orientation rather than performance goal orientation; cultivating intrinsic interest in the subject and put less emphasis on grades but make grading criteria explicit; emphasizing teaching approaches that encourage collaboration among students and cater for a range of teaching styles; explaining the reasons for, and the implications of, tests; providing feedback to students about their performance in a form that is non-egoinvolving and non-judgemental and helping students to interpret it; broadening the range of information used in assessing the attainment of individual students. The continuous assessment methodology developed was applied in 2007/08 and 2008/09, having found an increase in the approval from 25% to 55% (30%), accompanied by a decrease of the drop out from 41% to 23,5% (17,5%). Flunking with a numerical grade lowered from 34,4% to 22,0% (12,4%). The perception by the students of the continuous assessment relevance was evaluated with a questionnaire. 70% of the students that failed the course respond that, nevertheless, didn’t repent having done the continuous assessment.

Performance evaluation of hospitals that provide care in the public health system, Brazil

OBJECTIVE To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System.METHODS This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction.RESULTS The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed.CONCLUSIONS The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.

A percepção dos profissionais de saúde sobre o trabalho em equipa no contexto do Hospital do Espírito Santo de Évora, E.P.E.

Mestrado em Intervenção Sócio-Organizacional na Saúde - Área de especialização: Políticas de Administração e Gestão de Serviços de Saúde

O papel dos sistemas de informação do Hospital de Curry Cabral na gestão hospitalar

Mestrado em Intervenção Sócio-Organizacional na Saúde - Área de especialização: Políticas de Administração e Gestão de Serviços de Saúde

Qualidade dos sistemas de informação no serviço de radiologia do Hospital de Curry Cabral: um estudo de caso

Mestrado em Intervenção Sócio-Organizacional na Saúde - Área de especialização: Políticas de Administração e Gestão de Serviços de Saúde

Readmission of older patients after hospital discharge for hip fracture: a multilevel approach

ABSTRACT OBJECTIVE To identify individual and hospital characteristics associated with the risk of readmission in older inpatients for proximal femoral fracture in the period of 90 days after discharge. METHODS Deaths and readmissions were obtained by a linkage of databases of the Hospital Information System of the Unified Health System and the System of Information on Mortality of the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 or older, with non-elective hospitalization for proximal femoral fracture was followed for 90 days after discharge. Cox multilevel model was used for discharge time until readmission, and the characteristics of the patients were used on the first level and the characteristics of the hospitals on the second level. RESULTS The risk of readmission was higher for men (hazard ratio [HR] = 1.37; 95%CI 1.08–1.73), individuals more than 79 years old (HR = 1.45; 95%CI 1.06–1.98), patients who were hospitalized for more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplasty when compared with the ones who underwent osteosynthesis (HR = 0.57; 95%CI 0.41–0.79). Besides, patients admitted to state hospitals had lower risk for readmission when compared with inpatients in municipal (HR = 1.71; 95%CI 1.09–2.68) and federal hospitals (HR = 1.81; 95%CI 1.00–3.27). The random effect of the hospitals in the adjusted model remained statistically significant (p < 0.05). CONCLUSIONS Hospitals have complex structures that reflect in the quality of care. Thus, we propose that future studies may include these complexities and the severity of the patients in the analysis of the data, also considering the correlation between readmission and mortality to reduce biases.

Reshaping higher education systems in the MENA region: the contribution of remote and virtual labs

Learning is not only happening in school or university; it is also an important aspect of the daily life that allows students to remain in their biological and physical environment helping to reshape it, by applying what they have learnt. Today, the higher education sector is a part of important strategies used by countries in order to foster their development. Despite its geographical location, i.e. its closeness to Europe and Asia, the MENA (Middle East and North Africa) region still needs an integrated strategy for the advancement, reform, and update of its higher educational landscape. Although some solutions have been experimented in the region in the field of higher education, they have not been able to raise the quality of education to the level comparable that observed in developed countries. In other words, many MENA higher education systems are facing problems, for which solution ought to be sought. We analyse the situation of higher education systems in the MENA countries and the factors that affect the delay in achieving the level of education existing in other world regions, e.g. Europe, especially in the higher education sector. During the discussion, the impact of new technology-enhanced tools, such as remote laboratories, in the process of development and consolidation of MENA universities, is particularly stressed.