O planejamento estratégico no processo de implementação da política de atenção primária em um município da região metropolitana do Recife, Pernambuco, Brasil The strategic planning in the process of implementing the primary health care policy in a town in the metropolitan region of Recife, Pernambuco, Brazil ResumoEste estudo qualitativo utilizando a técnica do Discurso do Sujeito Coletivo, tem o objetivo de analisar as marcas do planejamento estratégico no processo de implementação da política de atenção primária municipal, e oferece uma discussão relacionada ao que representantes da gestão da Secretaria de Saúde do Jaboatão dos Guararapes, município da Região Metropolitana do Recife, Pernambuco, e do Conselho Municipal de Saúde refletem acerca do planejamento, orçamento e aspectos relacionados à Programação Anual de Saúde, com ênfase na atenção primária à saúde local. Há desconhecimento sobre a coerência das ações de Atenção Primária à Saúde planejadas comparadas às executadas. Isto demonstra que a construção de instrumentos de gestão por vezes serve apenas para atender a uma demanda legal, fazendo-se necessária a ampliação da discussão acerca da prática do Planejamento Estratégico institucional, com vistas a conferir direcionalidade ao processo de consolidação do Sistema Único de Saúde. AbstractThis qualitative study using the technique of collective subject speech, seeks to examine the marks in the strategic planning process for implementing the policy of municipal primary and offers a discussion relating to the management representatives of the Department of Health Jaboatão Guararapes , Municipality of Metropolitan Recife, Pernambuco, and the Municipal Health Council reflect on the planning, budgeting and other aspects related to the Annual Program of Health, with emphasis on primary health care site. There is a lack of consistency in the actions of Primary Health Care, planned, compared to those performed. This demonstrates that the construction of management instruments sometimes serves only to satisfy a legal demand, making it necessary to expand the discussion about the practice of institutional strategic planning, in order to give directionality to the process of consolidation of Health System.Descritores: planejamento estratégico, atenção primária à saúde, discurso do sujeito coletivo
PURPOSE Conversion chemotherapy is often used for borderline or unresectable (B/U) liver metastases from colorectal cancer (CRC) with the aim of achieving resectability. Although intensive and costly regimens are often used, the best regimen in this scenario remains unclear. We aimed to evaluate the outcomes of patients with B/U liver metastases from CRC treated with conversion chemotherapy with the modified fluorouracil, leucovorin, and oxaliplatin (mFLOX) regimen followed by metastasectomy. METHODS We performed a single-center retrospective analysis of patients with B/U liver metastases from CRC treated with chemotherapy with the mFLOX regimen followed by surgery. B/U disease was defined as at least one of the following: more than four lesions, involvement of hepatic artery or portal vein, or involvement of biliary structure. RESULTS Fifty-four consecutive patients who met our criteria for B/U liver metastases were evaluated. Thirty-five patients (64%) had more than four liver lesions, 16 (29%) had key vascular structure involvement, and 16 (29%) had biliary involvement. After chemotherapy, all patients had surgery and 42 (77%) had R0 resection. After a median follow-up of 37.2 months, median progression-free survival (PFS) was 16.9 months and median overall survival (OS) was 68.3 months. R1-R2 resections were associated with worse PFS and OS compared with R0 resection (PFS: hazard ratio, 2.65; P = .007; OS: hazard ratio, 2.90; P = .014). CONCLUSION Treatment of B/U liver metastases from CRC with conversion chemotherapy using mFLOX regimen followed by surgical resection was associated with a high R0 resection rate and favorable survival outcomes. On the basis of our results, we consider mFLOX a low-cost option for conversion chemotherapy among other options that have been proposed.
e17513 Background: Optimal treatment of synchronous tumors (ST) of the aerodigestive tract is debatable and care is often individualized. Our goal was to characterize patients with HNSCC and esophageal cancer (EC) ST and to establish prognostic factors that could aid therapeutic decision. Methods: In this retrospective observational study, we evaluated data from 1650 consecutive patients diagnosed with HNSCC from 2008 to 2016. Patients with ST of HNSCC and esophagus with an interval of ≤ 6 months between both diagnoses were included. Patients ≥ 6 months between both diagnoses, incomplete treatment information and presence of another tumor site were excluded. Results: 52 patients were eligible. Median age was 57 years (39-91). Most were male (98%), with smoking and drinking habits (98%) and ECOG 0-1 (73%). HNSCCs were mainly in oropharynx (54%) and locally advanced disease (LA, III-IVB) (88%). In contrast, EC was early stage (I-II, 62%), located in the thorax (94%) and squamous histology (96%). 14 (27%) had LA in both primaries. Most LA HNSCCs (85%) were treated with radiotherapy (RT) with a median dose of 70Gy (5-70Gy). 50% received platinum and taxane induction chemotherapy. 81% of initial EC received at least surgery, mucosectomy or RT (median 50.4Gy). Hospitalization due to toxicity occurred in 12 (23%) and 7 (14%) of HNSCC and EC treatments, respectively. 16 patients (31%) had no definitive treatment directed to EC, without apparent impact on survival. Median time to progression was 13.8 months, being HNSCC the most frequent site of progression/relapse (40%). Median survival was 23.9 months (IC 95% 9.2-38.6). Early HNSCC survival was comparable to LA HNSCC (17.3 vs. 23.9 mo, p = 0.98). In LA HNSCC, LA vs. initial EC carried a worse prognosis (16 vs. 36.3 mo, p = 0.008). Anemia, BMI, tobacco exposure had no impact on survival. Conclusions: The occurrence of EC and HNSCC ST leads to a dismal survival, even in patients with early stage HNSCC. The presentation of LA in both sites is particularly challenging and associated with worse prognosis. Given the rate of treatment-related toxicity in this population, cautious efforts should be employed when planning definitive treatment in ST pts.
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