RESUMO Introdução KEYWORDS-Palliative Care.-Education, Medical, Undergraduate.-Internship and Residency.-Aged.-Neoplasms. ABSTRACT Background:There is a growing need to use palliative care (and support care) in health areas, particularly in Medicine. This is due to an aging population and the increased prevalence of chronic

Objetivo: Descrever dados epidemiológicos e principais desfechos de pacientes admitidos em uma unidade de terapia intensiva de um hospital público do DF.Métodos: Estudo observacional retrospectivo que incluiu todos pacientes admitidos na UTI do Hospital Regional do Paranoá (Brasília- DF) no período de abril/2004 a março/2009. Foram avaliados idade, gênero, local de residência, motivo da internação, APACHE II, dependência para mobilidade prévia à internação na UTI, uso de aminas vasoativas, necessidade de ventilação mecânica invasiva, tempo de ventilação mecânica, úlcera de pressão no momento da admissão e alta da UTI, tempo de internação e mortalidade na UTI.Resultados: Foram incluídos 189 pacientes com APACHE II de 31,6±10,6 e idade de 77,4±10,9 anos. A maioria dos pacientes eram idosos. 179 apresentavam idade superior a 60 anos (94,6%), 71 (37,5%) dos quais tinham idade acima de 80 anos. Os principais motivos de internação foram as doenças respiratórias (28,6%, N=54), fratura de quadril (27,5%, N=52) e doenças cardiovasculares (15,6%, N=30). Nessa amostra, a mortalidade foi de 38,6% (N=73). Os pacientesnão sobreviventes apresentaram maiores APACHE II (36,5±10,8 versus 28,1±9,4, p=0,00), tempo de internação na UTI acima de 2 semanas (45,2% versus 30,2%, p=0,04), dependência funcional para mobilidade (48,8% versus 8,2%, p=0,04), necessidade de aminas vasoativas (71,4% versus 14,4%, p=0,00) e uso de ventilação mecânica invasiva (69,5% versus 8,9%, p=0,00).Conclusão: A população de idosos (acima de 65 anos) e muito idosos (acima de 80 anos) constituíram a maior proporção dos pacientes admitidos. A mortalidade foi elevada e esteve associada ao grau de severidade da doença aguda e ao estado funcional prévio do paciente à admissão.

No abstract

SUMMARY OBJECTIVE Exploring the use of forecasting models and simulation tools to estimate demand and reduce the waiting time of patients in Emergency Departments (EDs). METHODS The analysis was based on data collected in May 2013 in the ED of Recanto das Emas, Federal District, Brasil, which uses a Manchester Triage System. A total of 100 consecutive patients were included: 70 yellow (70%) and 30 green (30%). Flow patterns, observed waiting time, and inter-arrival times of patients were collected. Process maps, demand, and capacity data were used to build a simulation, which was calibrated against the observed flow times. What-if analysis was conducted to reduce waiting times. RESULTS Green and yellow patient arrival-time patterns were similar, but inter-arrival times were 5 and 38 minutes, respectively. Wait-time was 14 minutes for yellow patients, and 4 hours for green patients. The physician staff comprised four doctors per shift. A simulation predicted that allocating one more doctor per shift would reduce wait-time to 2.5 hours for green patients, with a small impact in yellow patients’ wait-time. Maintaining four doctors and allocating one doctor exclusively for green patients would reduce the waiting time to 1.5 hours for green patients and increase it in 15 minutes for yellow patients. The best simulation scenario employed five doctors per shift, with two doctors exclusively for green patients. CONCLUSION Waiting times can be reduced by balancing the allocation of doctors to green and yellow patients and matching the availability of doctors to forecasted demand patterns. Simulations of EDs’ can be used to generate and test solutions to decrease overcrowding.

No abstract

No abstract

No abstract

Background:The trading system is one of the main modalities of the bidding process for the acquisition of medicines, mainly through rationalization, agility, transparency of the process and economy.Objective: To evaluate the influence of the electronic trading processes in the management of public hospital pharmaceutical services.Methods: This is an observational, transversal and retrospective study, in which the bidding processes for 2015 of a teaching hospital in the state of Sergipe were analyzed. The internal processes and technical opinions, as well as the minutes of the electronic trading sessions available at www.comprasgovernamental.gov.br, were used as sources of information and data collection.Results: Eight bidding processes were analyzed, with a total of 199 items tendered, of which 25.6% were unsuccessful and 7% remained deserted. There was an average of 158.87 days to complete the entire bidding process. The main reasons for the failure of the items were the non-compliance with the documentation required in the bidding process (42.4%) and the value of the proposals being above the estimated (17%). As for the XYZ classification of the failed and deserted items, 18.5% were classified as of the highest criticality (Z).Conclusions: The time for completion of the bidding processes was extensive, mainly referring to the internal phase, which ratifies the need to establish deadlines for completion of the steps with the intuition of speeding up the purchase process. Deserted and failed bids may directly influence the patient's clinical outcome due to the shortage of medicines and medical-hospital supplies, and consequently the discontinuity of care provided to the patient.