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This study aimed at analyzing the performance of four forecasting models in predicting the demand for medical care in terms of daily visits in an emergency department (ED) that handles high complexity cases, testing the influence of climatic and calendrical factors on demand behavior. We tested different mathematical models to forecast ED daily visits at Hospital de Clínicas de Porto Alegre (HCPA), which is a tertiary care teaching hospital located in Southern Brazil. Model accuracy was evaluated using mean absolute percentage error (MAPE), considering forecasting horizons of 1, 7, 14, 21, and 30 days. The demand time series was stratified according to patient classification using the Manchester Triage System's (MTS) criteria. Models tested were the simple seasonal exponential smoothing (SS), seasonal multiplicative Holt-Winters (SMHW), seasonal autoregressive integrated moving average (SARIMA), and multivariate autoregressive integrated moving average (MSARIMA). Performance of models varied according to patient classification, such that SS was the best choice when all types of patients were jointly considered, and SARIMA was the most accurate for modeling demands of very urgent (VU) and urgent (U) patients. The MSARIMA models taking into account climatic factors did not improve the performance of the SARIMA models, independent of patient classification.

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Objective:to identify risk factors for falls in hospitalized adult patients. Methods:a matched case-control study (one control for each case). A quantitative study conducted in clinical and surgical units of a teaching hospital in Southern Brazil. The sample comprised 358 patients. Data were collected over 18 months between 2013-2014. Data analysis was performed with descriptive statistics and conditional logistic regression using Microsoft Excel and SPSS version 18.0. Results:risk factors identified were: disorientation/confusion [OR 4.25 (1.99 to 9.08), p<0.001]; frequent urination [OR 4.50 (1.86 to 10.87), p=0.001]; walking limitation [OR 4.34 (2.05 to 9.14), p<0.001]; absence of caregiver [OR 0.37 (0.22 to 0.63), p<0.001]; postoperative period [OR 0.50 (0.26 to 0.94), p=0.03]; and number of medications administered within 72 hours prior the fall [OR 1.20 (1.04 to 1.39) p=0.01]. Conclusion:risk for falls is multifactorial. However, understanding these factors provides support to clinical decision-making and positively influences patient safety.

The changing process of health care services affects the University Hospitals (UH) in a particular manner. This paper aims to analyse the challenges and future perspectives of the Brazilian UH. In order to do so, only the UH affiliated to the Brazilian Federal Teaching Institutions were analysed. There is a substantial heterogeneity amongst UH in Brazil, in terms of size and organizational structure as well as in the type of health care provided. Brazilian UH represent core elements of two State policies: Education and Health. Consequently, the existing tensions between these two policies, to some extent, often reflect on the UH. Also, the UH must frequently address challenges that go beyond their purpose. Organizational sustainability remains a crucial issue to the UH. This concept entails effective financial and management skills, outcomes monitoring and evaluation mechanisms, and accountability. UH in Brazil have two main roles: providing health care and integrating the National Health System. From a future perspective, the UH shall be conceived from a much broader perspective than that of institutions that only provide health care. The future of Brazilian UH relies on their capacity to provide effective support to the State Health and Education policies.

Aim:To develop and validate a predictive model for falls in hospitalized adult clinical and surgical patients, assessing intrinsic (i.e. patient-related) and extrinsic factors (i.e. care process-related). Background:To identify factors predictive of falls and enable appropriate management of fall risk it is necessary to understand patient and environmental factors, along with care delivery processes. Design:A matched case-control study. Methods:This study was conducted in the medical and surgical wards of a Brazilian teaching hospital. The sample included 536 patients, with data collected in 2013- Data analysis included descriptive statistics and conditional logistic regression.Cases of patients aged 18 years or older who fell while hospitalized were included.One patient who did not fall during hospitalization, matched by sex, ward and admission date, was selected as a control for each included case. Results: The SAK Fall Scale (Severo-Almeida-Kuchenbecker) was developed and validated. The scale includes seven variables: disorientation/confusion, frequent urination, walking limitations, lack of caregiver, postoperative status, previous falls and number of medications administered within 72 hr prior to the fall. This scale showed acceptable predictive accuracy. Conclusions: The newly developed SAK Fall Scale includes five intrinsic and two extrinsic variables and differs from other predictive scales for falls. The findings of this study are broad and the scale, which is easy to apply, can be used worldwide by nurses in health services. In advanced practice, the testing of a new model for fall risk contributes to preventive interventions and thus has an impact on patient safety. K E Y W O R D S adult, advanced practice, falls, nurses, patient safety, risk management *Member of the Study Group on Adult and Elderly Care -GEPECADI -CNPq.• The study gives data for a new prediction model that should be used to predict fall risk.• The findings should be used to support the care and safety of hospitalized clinical and surgical patients. 564 | SEVERO ET AL.

Esta revisão de escopo objetiva descrever e caracterizar o sistema de farmacovigilância do Brasil (SINAF) e averiguar o atendimento aos requisitos mínimos propostos pela Organização Mundial da Saúde para um desempenho funcional de sistemas nacionais dessa natureza. A estratégia de pesquisa bibliográfica utilizou recomendações do STARLITE e termos de busca nas bases de dados MEDLINE/PubMed, Google, Imprensa Nacional e website da Agência Nacional de Vigilância Sanitária (Anvisa), compreendendo o período entre 1999, ano de criação da Anvisa, e março de 2016. Foram incluídas 47 (4,4%) publicações, de um total de 1.068 identificadas, prevalecendo, nesta ordem: 14 normas jurídicas (29,8%), 13 (27,6%) documentos técnicos e 10 (21,3%) artigos científicos. Os estudos e documentos técnicos analisados compreenderam a criação, em âmbito federal, da primeira unidade técnica de farmacovigilância do sistema de notificação de eventos adversos, o Centro Nacional de Monitorização e a Câmara Técnica de Medicamentos. A taxa de notificação de eventos adversos a medicamentos no Brasil correspondeu, em 2013, a 36 notificações/1 milhão de habitantes, bastante inferior à meta proposta na literatura internacional, que sugere 300 notificações/1 milhão de habitantes. Este estudo identificou aspectos estruturais e funcionais que podem comprometer o desempenho do SINAF, como a falta de legislação que institua oficialmente o próprio sistema e suas finalidades.