Introduction: Multidimensional efficiency analysis can provide important insights into the performance of hospitals.In this paper, we propose a multidimensional model based on Data Envelopment Analysis (DEA) to investigate and compare the efficiency of public hospitals in Brazil. Methods: Data from 21 public hospitals were collected from public databases (OECD -Organization for Economic Co-operation and Development; SIH-SUS -SUS Hospital Information System, Datasus, Brazil). Four inputs (Number of medical and non-medical staff, Annual revenue, Number of beds, Average length of patient hospitalization), four Variables of Influence (Type of hospital, Accredited hospital, Number of medical specialties, Resources from government) and four Outputs (Number of outpatient care services, Number of hospitalizations, Number of surgeries, Number of exams) were used to feed the DEA model. Results: Seven hospital units reach 100% efficiency and, according to DEA, can be considered efficient units. Two units were considered "almost efficient" and the remaining twelve units perform poorly, considering the data supplied to the DEA model. As a whole, the average efficiency of the hospitals investigated was 79% (0.79). Conclusion: A very heterogeneous performance has been found among the Brazilian public hospitals investigated. Besides, the reasonably low average efficiency seems to indicate that the system has a large potential for improvement in almost all areas associated with the input and output variables investigated in this paper.Keywords Hospital efficiency, Data Envelopment Analyses, Public hospital.This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.How to cite this article: Soares AB, Pereira AA, Milagre ST. A model for multidimensional efficiency analysis of public hospital management.

When a dysfunction occurs in any component of the stomatognathic system, temporomandibular disorders (TMD) may originate. The aim of this study was to compare the deviations, displacement and the execution speed of mandibular movements among asymptomatic participants and those with TMD. Convenience sampling was used; forty participants diagnosed by clinical evaluation following the Research Diagnostic Criteria for Temporomandibular Disorders were divided into three groups: arthropathy (GART, 10 participants, 40% men), myopathy (GMYO, 10 participants, 30% men), and the control group (CG, 20 asymptomatic participants, 25% men). Participants were asked to perform the movements of free maximal mouth opening and closing, right and left lateral excursions, and protrusion with sliding teeth contacts. The mandibular trajectory was recorded using opto-electronic devices tracking reflective markers placed in front of the 'soft tissue pogonion point'. The movements were analysed on the following axis: x - medial-lateral, y - vertical, z - antero-posterior. Significative differences were found in CGxGART - unassisted maximal mouth opening and closing projection on y-axis (OCY), CGxGMYO - unassisted maximal mouth opening and closing projection on x-axis (OCX), and in the measures Opening lateral deviation on x-axis (OLDX), closing lateral deviation on x-axis (CLDX) and in the measures of speed for both. In regard to GARTxGMYO, a significative difference was found in Protrusion lateral deviation on x-axis (PLDX) 'Conover-Iman Test of Multiple Comparisons Using Rank Sums' using Bonferroni correction (P < 0·05). In conclusion, the total opening movements in individuals with TMD tended to have higher deviation than in those asymptomatic individuals and a reduction in the speed of movements.

Introdução: A malária é uma doença endêmica na Amazônia Legal Brasileira, apresentando riscos diferentes para cada região. O Município de Cantá, no Estado de Roraima, apresentou para todo o período estudado, um dos maiores índices parasitários anuais do Brasil, com valor sempre maior que 50. O presente estudo visa à utilização de uma rede neural artificial para previsão da incidência da malária nesse município, a fim de auxiliar os coordenadores de saúde no planejamento e gestão dos recursos.

Purpose The aim of this study was to carry out a systematic review of telemedicine technology and to discuss the role of legislation in the application of telemedicine technology within the scope of COVID-19. Methods The search for papers was conducted in the databases Cochrane Central, MEDLINE, and Embase. The keywords considered for this systematic review were (coronavirus OR “2019-nCoV” OR 2019nCoV OR nCoV2019 OR “nCoV-2019” OR “COVID-19” OR COVID19 OR “HCoV-19” OR HCoV19 OR CoV OR “2019 novel*” OR Ncov OR “n-cov” OR “SARS-CoV-2” OR “SARSCoV-2” OR “SARSCoV2” OR “SARSCoV2” OR SARSCov19 OR “SARS-Cov19” OR “SARS-Cov-19” OR “severe acute respiratory syndrome*” OR ((corona* OR corono*) AND (virus* OR viral* OR virinae*))) AND ((telemedicine OR telehealth OR “remote assessment” OR telemonitoring)). The review process was carried out by six independent reviewers, using the PRISMA-P method. Results As a result, a total of 34 papers were selected, which addressed the study of telemedicine technologies used in times of endemics, epidemics, and pandemics, focusing on COVID-19. Conclusion Telemedicine allows for care in remote areas and at a lower cost to the patient and, in the current situation, it can reduce the number of contagions as well as the occupation of beds in health facilities. Telemedicine may suffer from limitations, mainly due to current legislation, but in this pandemic era of COVID-19, several countries around the world have made their laws more flexible to allow more widespread use of telemedicine.

Resumo A Engenharia Clínica é uma área com atuação nos Estabelecimentos Assistenciais de Saúde, desenvolvendo atividades baseadas nos conhecimentos de engenharia e de gerenciamento aplicadas às tecnologias de saúde. Nesse contexto, este trabalho relata os impactos econômicos da aplicação de técnicas de gestão em Engenharia Clínica num hospital público brasileiro de grande porte e referência em alta complexidade-Hospital de Clínicas da Universidade Federal de Uberlândia. Trata-se de uma pesquisa quantitativa, onde foram consideradas questões econômicas e de qualidade, suportada por pesquisa documental. O levantamento de dados baseou-se em relatórios e documentos administrativos do hospital do período de 2001 a 2010, referentes a recursos humanos, indicadores de serviços, indicadores de qualidade, custos com peças e contratos. Dentre os resultados encontrados, destaca-se a redução de aproximadamente 20% nas manutenções corretivas e sua estabilização ao longo do tempo, mesmo em face de um elevado aumento do parque tecnológico da instituição. No montante global de gastos com contratos, observou-se uma redução de cerca de 65% no período avaliado. A economia gerada pela gestão em Engenharia Clínica para a instituição foi de aproximadamente R$ 2 milhões em 2010, e a economia acumulada no período de 2001 a 2010 foi de R$ 7,6 milhões. Concluiu-se, que a gestão em Engenharia Clínica na instituição possibilitou uma redução significativa nos custos por meio da formação e capacitação de uma equipe própria, da redução dos custos com contratos e melhor planejamento das manutenções. Tais resultados demonstram a importância de um serviço de Engenharia Clínica para a melhor gestão de custos e das tecnologias em hospitais, sejam eles públicos ou privados. Palavras-chave Gestão hospitalar, Tecnologias em saúde, Custos, Manutenção. Economic evaluation of implementing a service of Clinical Engineering in a Brazilian public hospital Abstract Clinical Engineering is an important area for health care facilities, capable of applying engineering and management techniques to improve health technologies. In this context, this paper reports the economic impacts of the application of clinical engineering management techniques in a large Brazilian public hospital, which is also a reference for high complexity medical procedures-General Hospital of the Federal University of Uberlândia. The discussion is supported by a quantitative documentary research, which took into account not only the economic aspects, but also the quality of the service provided. The survey was based on reports and administrative documents from 2001 to 2010, related to human resources, service and quality indicators, costs of parts and contracts. Among the findings, it was observed a reduction of approximately 20% in corrective maintenance and their stabilization over time, even as the technological park of the institution increased. As for the overall amount of cost with contracts, there was a reduction of approximately 65% during the period.

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a b s t r a c tThe taxonomy of the N 2 -fixing bacteria belonging to the genus Bradyrhizobium is still poorly refined, mainly due to conflicting results obtained by the analysis of the phenotypic and genotypic properties. This paper presents an application of a method aiming at the identification of possible new clusters within a Brazilian collection of 119 Bradyrhizobium strains showing phenotypic characteristics of B. japonicum and B. elkanii. The stability was studied as a function of the number of restriction enzymes used in the RFLP-PCR analysis of three ribosomal regions with three restriction enzymes per region. The method proposed here uses clustering algorithms with distances calculated by average-linkage clustering. Introducing perturbations using sub-sampling techniques makes the stability analysis. The method showed efficacy in the grouping of the species B. japonicum and B. elkanii. Furthermore, two new clusters were clearly defined, indicating possible new species, and sub-clusters within each detected cluster.