ABSTRACT
Objetivo: Estudar como se dão as relações entre hospitais e empresasde apoio diagnóstico e terapêutico, averiguando se são relações demercado ou se apresentam comportamento de redes. Além disso,busca-se definir as conseqüências do tipo de relação para o acessoa conhecimento, aprendizado e inovação. Métodos: Realizou-seestudo de casos múltiplos em quatro hospitais privados de grandeporte, considerados de excelência, no município de São Paulo, emseus serviços de diagnóstico por imagem, laboratórios de análisesclínicas e bancos de sangue. Procedeu-se a entrevistas para obter apercepção de executivos e proprietários das organizações (hospitais eempresas prestadoras de serviços) quanto às variáveis do modelo daTeoria das Redes. A análise utilizou a técnica de adequação ao padrão. Resultados: O estudo demonstrou que as organizações apresentamcaracterísticas de redes. Existem interações padronizadas e complexas,com troca de conhecimento e aprendizado mútuo. Há evidências deque ocorre colaboração, operacional e estratégica, para geração desoluções, criação de novos produtos ou serviços e para implementaçãode novas tecnologias. As relações têm longa duração e as ações sãointerdependentes. Não são uma típica interação clientefornecedor demercado, tampouco representam uma expressão típica da hierarquia.Conclusão: O presente trabalho pode gerar informações úteis para aconfecção de um instrumento de pesquisa quantitativo e, a partir dasinformações contidas neste trabalho, pode-se também agora estimarum tamanho adequado para uma amostra representativa.
Objective: To study how hospitals and their diagnosis and treatmentsupplies relate to each other, analyzing if they have market relations orbehave as networks of organizations. Furthermore, the study tries toset the consequences of such relation in terms of access to knowledge,learning and innovation. Methods: A multiple case study performedat four top large private hospitals in São Paulo (Brazil), involving theiroutsourced laboratory, imaging and hemotherapy services. Individualinterviews were conducted with managers and owners of bothorganizations (hospitals and vendors) using semi-structured questionsto ascertain selected independent and dependent variables. The analysisused pattern-matching techniques. Results: The study demonstratedthey behave as networks. There are standard and complex interactions,with mutual exchange of knowledge and learning. There is strategic andoperational collaboration to find solutions, generating new products andservices and implementing new technologies. The relationships are longstanding and actions are interdependent. It is not a typical client-supplier interaction neither a characteristic expression of hierarchy. Conclusion: the present paper can provide useful information to prepare a quantitative research tool; based on this information, it is possible to estimate theadequate size of a representative sample.
Subject(s)
Diagnostic Services , Hospitals , Outsourced Services , Computer Communication NetworksABSTRACT
Episodic paroxysmal hemicrania (EPH) is a rare disorder characterized by frequent, daily attacks of short-lived, unilateral headache with accompanying ipsilateral autonomic features. EPH has attack periods which last weeks to months separated by remission intervals lasting months to years, however, a seasonal variation has never been reported in EPH. We report a new case of EPH with a clear seasonal pattern: a 32-year-old woman with a right-sided headache for 17 years. Pain occurred with a seasonal variation, with bouts lasting one month (usually in the first months of the year) and remission periods lasting around 11 months. During these periods she had headache from three to five times per day, lasting from 15 to 30 minutes, without any particular period preference. There were no precipitating or aggravating factors. Tearing and conjunctival injection accompanied ipsilaterally the pain. Previous treatments provided no pain relief. She completely responded to indomethacin 75 mg daily. After three years, the pain recurred with longer attack duration and was just relieved with prednisone. We also propose a new hypothesis: the EPH-cluster headache continuum