854 resultados para Difficult times


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Dissertação de mestrado integrado em Engenharia de Materiais

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Magdeburg, Univ., Fak. für Mathematik, Diss., 2010

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Magdeburg, Univ., Fak. für Verfahrens- und Systemtechnik, Diss., 2010

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The rural associationism developed from the last decades of the XIX century could be consider as an answer of the agriculturists to the increasing integration of agriculture in the market, and to the effects of the Great Depression. In the case of Spain, the initiatives in this sense arose with certain delay in relation to the countries of Western Europe. The beginning of the Spanish cooperativism is closely bound to the Law of 1906. It granted the agrarian cooperatives with fiscal exemptions and other types of supports to the associates, although the process did not really accelerate until the promulgation of the law regulation in 1908.

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The author studied some protective behaviors of Biomphalaria glabrata (vertical movements, response to molluscicides and response to water currents) and demonstrated how these activities hamper the control of this snail, which is the main vector of schistosomiasis in Brazil.

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Introduction: Drug prescription is difficult in ICUs as prescribers are many, drugs expensive and decisions complex. In our ICU, specialist clinicians (SC) are entitled to prescribe a list of specific drugs, negotiated with intensive care physicians (ICP). The objective of this investigation was to assess the 5-year evolution of quantity and costs of drug prescription in our adult ICU and identify the relative costs generated by ICP or SC. Methods: Quantities and costs of drugs delivered on a quarterly basis to the adult ICU of our hospital between 2004 and 2008 were extracted from the pharmacy database by ATC code, an international five-level classification system. Within each ATC first level, drugs with either high level of consumption, high costs or large variations in quantities and costs were singled out and split by type of prescriber, ICP or SC. Cost figures used were drug purchase prices by the hospital pharmacy. Results: Over the 5-year period, both quantities and costs of drugs increased, following a nonsteady, nonparallel pattern. Four ATC codes accounted for 80% of both quantities and costs, with ATC code B (blood and haematopoietic organs) amounting to 63% in quantities and 41% in costs, followed by ATC code J (systemic anti-infective, 20% of the costs), ATC code N (nervous system, 11% of the costs) and ATC code C (cardiovascular system, 8% of the costs). Prescription by SC amounted to 1% in drug quantities, but 19% in drug costs. The rate of increase in quantities and costs was seven times larger for ICP than for SC (Figure 1 overleaf ). Some peak values in costs and quantities were related to a very limited number of patients. Conclusions: A 5-year increase in quantities and costs of drug prescription in an ICU is a matter of concern. Rather unexpectedly, total costs and cost increases were generated mainly by ICP. A careful follow-up is necessary to try influencing this evolution through an institutional policy co-opted by all professional categories involved in the process.