Métodos de avaliação do impacto económico dos eventos adversos em meio hospitalar

RESUMO - O sistema de saúde é constantemente sujeito a pressões sendo as mais relevantes a pressão para o aumento da qualidade e a necessidade de contenção de custos. Os Eventos Adversos (EAs) ocorridos em meio hospitalar constituem um sério problema de qualidade na prestação de cuidados de saúde, com consequências clinicas, sociais, económicas e de imagem, que afectam pacientes, profissionais, organizações e o próprio sistema de saúde. Os custos associados à ocorrência de EAs em meio hospitalar, incrementam significativamente os custos hospitalares, representando cerca de um em cada sete dólares gastos no atendimento dos doentes. Só na última década surgiram estudos com o objectivo principal de avaliar esse impacto em meio hospitalar, subsistindo ainda uma grande indefinição quanto às variáveis e métodos a utilizar. O objectivo principal deste trabalho de projecto foi conhecer e caracterizar as diferentes metodologias utilizadas para avaliação dos custos económicos, nomeadamente dos custos directos, relacionados com a ocorrência de eventos adversos em meio hospitalar. Tendo em atenção as dificuldades referidas, utilizou-se como metodologia a revisão narrativa da literatura, complementada com a realização de uma técnica de grupo nominal. Os resultados obtidos foram os seguintes: i) a metodologia utilizada na maioria dos estudos para determinar a frequência, natureza e consequências dos EAs ocorridos em meio hospitalar, utiliza matrizes de base observacional, analítica, com base em estudos de coorte retrospectivo recorrendo aos critérios definidos pelo Harvard Medical Practice Study; ii) a generalidade dos estudos realizados avaliam os custos directos dos EAs em meio hospitalar, iii) verificou-se a existência de uma grande diversidade de métodos para a determinação dos custos associados aos EAs. A generalidade dos estudos determina esse valor com base na contabilização do número de dias adicionais de internamento, resultantes do EA, valorizados com base em custos médios; iv) o grupo de peritos, propôs como metodologia para a determinação do custo associado a cada EA, a utilização de sistemas de custeio por doente; v) propõe-se o desenvolvimento de uma plataforma informática, que permita o cruzamento da informação disponível no registo clinico electrónico do doente com um sistema automático de identificação de EAs, a desenvolver, e com sistemas de custeio por doente, de modo a valorizar os custos por doente e por tipo de EA. A avaliação dos custos directos associados à ocorrência de EAs em contexto hospitalar, pelo impacto económico e social que tem nos doentes e organizações, será seguramente uma das áreas de estudo e investigação futuras, no sentido de melhorar a eficiência do sistema de saúde e a qualidade e segurança dos cuidados prestados aos doentes.

40 K neon liquid energy storage unit

Cryocoolers have been progressively replacing the use of the stored cryogens in cryogenic chains used for detector cooling, thanks to their higher and higher reliability. However, the mechanical vibrations, the electromagnetic interferences and the temperature fluctuations inherent to their functioning could reduce the sensor’s sensitivity. In order to minimize this problem, compact thermal energy storage units (ESU) are studied, devices able to store thermal energy without significant temperature increase. These devices can be used as a temporary cold source making it possible to turn the cryocooler OFF providing a proper environment for the sensor. A heat switch is responsible for the thermal decoupling of the ESU from the cryocooler’s temperature that increases when turned OFF. In this work, several prototypes working around 40 K were designed, built and characterized. They consist in a low temperature cell that contains the liquid neon connected to an expansion volume at room temperature for gas storage during the liquid evaporation phase. To turn this system insensitive to the gravity direction, the liquid is retained in the low temperature cell by capillary effect in a porous material. Thanks to pressure regulation of the liquid neon bath, 900 J were stored at 40K. The higher latent heat of the liquid and the inexistence of triple point transitions at 40 K turn the pressure control during the evaporation a versatile and compact alternative to an ESU working at the triple point transitions. A quite compact second prototype ESU directly connected to the cryocooler cold finger was tested as a temperature stabilizer. This device was able to stabilize the cryocooler temperature ((≈ 40K ±1 K) despite sudden heat bursts corresponding to twice the cooling power of the cryocooler. This thesis describes the construction of these devices as well as the tests performed. It is also shown that the thermal model developed to predict the thermal behaviour of these devices,implemented as a software, describes quite well the experimental results. Solutions to improve these devices are also proposed.

Nanostructuring silicon probes via electrodeposition: characterization of electrode coatings for acute in vivo neural recordings

Understanding how the brain works will require tools capable of measuring neuron elec-trical activity at a network scale. However, considerable progress is still necessary to reliably increase the number of neurons that are recorded and identified simultaneously with existing mi-croelectrode arrays. This project aims to evaluate how different materials can modify the effi-ciency of signal transfer from the neural tissue to the electrode. Therefore, various coating materials (gold, PEDOT, tungsten oxide and carbon nano-tubes) are characterized in terms of their underlying electrochemical processes and recording ef-ficacy. Iridium electrodes (177-706 μm2) are coated using galvanostatic deposition under different charge densities. By performing electrochemical impedance spectroscopy in phosphate buffered saline it is determined that the impedance modulus at 1 kHz depends on the coating material and decreased up to a maximum of two orders of magnitude for PEDOT (from 1 MΩ to 25 kΩ). The electrodes are furthermore characterized by cyclic voltammetry showing that charge storage capacity is im-proved by one order of magnitude reaching a maximum of 84.1 mC/cm2 for the PEDOT: gold nanoparticles composite (38 times the capacity of the pristine). Neural recording of spontaneous activity within the cortex was performed in anesthetized rodents to evaluate electrode coating performance.

Impact of an intervention in the use of sequential antibiotic therapy in a Brazilian university hospital

INTRODUCTION: Sequential antibiotic therapy (SAT) is safe and economical. However, the unnecessary use of intravenous (IV) administration usually occurs. The objective of this work was to get to know the effectiveness of an intervention to implement the SAT in a teaching hospital in Brazil. METHODS: This was a prospective and interventional study, historically controlled, and was conducted in the Hospital de Clínicas, Universidade Federal de Uberlândia, State of Minas Gerais, Brazil, a high complexity teaching hospital having 503 beds. In each of the periods, from 04/04/05 to 07/20/05 (pre-intervention) and from 09/24/07 to 12/20/07 (intervention), 117 patients were evaluated. After the pre-intervention period, guidelines were developed which were implemented during the intervention period along with educational measures and a reminder system added to the patients' prescription. RESULTS: In the pre-intervention and intervention periods, the IV antibiotics were used as treatment for a average time of 14.8 and 11.8 days, respectively. Ceftriaxone was the antibiotic most prescribed in both periods (23.4% and 21.6% respectively). Starting from the first prescription of antibiotics, the average length of hospitalization time was 21.8 and 17.5 days, respectively. The SAT occurred only in 4 and 5 courses of treatment, respectively, and 12.8% and 18.8% of the patients died in the respective periods. CONCLUSIONS: Under the presented conditions, the evaluated intervention strategy is ineffective in promoting the exchange of the antibiotic administration from IV to oral treatment (SAT).

A consumer research project as the basis for the development of a marketing plan for a new spirit brand producing gin in Germany

This work project is about developing a marketing plan for a new gin brand in Germany. It is based on consumer and market research, including Portugal as a trend market for the qualitative research. For the undertaking it is seen as fundamental to understand the industry as well as the consumer needs, attitudes and preferences. Furthermore, it is important to consider the estimation of opinion leaders and trendsetters in the industry. In this context it turned out that barkeepers have a key-influencing role for the stimulation of demand. Based on the insights from this research as well as on the gained market knowledge, the marketing plan was developed. The goal is to convince other brand users to switch brands.

Improving silicon probe performance through layer-by-layer coating

Fully comprehending brain function, as the scale of neural networks, will only be possi-ble with the development of tools by micro and nanofabrication. Regarding specifically silicon microelectrodes arrays, a significant improvement in long-term performance of these implants is essential. This project aims to create a silicon microelectrode coating that provides high-quality electrical recordings, while limiting the inflammatory response of chronic implants. To this purpose, a combined chitosan and gold nanoparticles coating was produced allied with electrodes modification by electrodeposition with PEDOT/PSS in order to reduce the im-pedance at 1kHz. Using a dip-coating mechanism, the silicon probe was coated and then charac-terized both morphologically and electrochemically, with focus on the stability of post-surgery performance in anesthetized rodents. Since not only the inflammatory response analysis is vital, the electrodes recording degradation over time was also studied. The produced film presented a thickness of approximately 50 μm that led to an increase of impedance of less than 20 kΩ in average. On a 3 week chronic implant, the impedance in-crease on the coated probe was of 641 kΩ, compared with 2.4 MΩ obtained for the uncoated probe. The inflammatory response was also significantly reduced due to the biocompatible film as proved by histological tests.