Construction and effectiveness evaluation of surgical complication monitoring mode based on medical record homepage data / 中华医院管理杂志

Objective:To explore the establishment of a surgical complication monitoring mode based on data on the medical record homepage, and analyze its impact on the trend of changes in surgical complication incidence.Methods:A monitoring mode of surgical complication was developed based on the " structure-process-results" framework by using surgical complication rates derived from performance appraisal for a tertiary general hospital in Guangzhou. The number of surgical complications and the number of discharged surgical patients was collected from the hospital from January 2019 to June 2022 through the home page collection system for performance appraisal of national tertiary public hospitals. Descriptive analysis was used to analyze the incidence of surgical complications, and Joinpoint regression was used to analyze the trend of changes in the incidence of surgical complications. Monthly percentage change ( MPC) and average monthly percentage change ( AMPC) were calculated. Results:Since the hospital began implementing the surgical complication monitoring mode in May 2021, the incidence of surgical complications had decreased from 2.55% in June 2021 to 0.82% in June 2022, with an MPC of -5.58% ( P=0.024), which was better than the changes from January 2019 to May 2021 ( MPC=0.18%, P=0.755). Conclusions:The surgical complication monitoring mode constructed by the hospital can effectively reduce the incidence of surgical complications, providing reference for optimizing hospital′s medical quality management process and decision-making mode.

Increasing the rate of timely completion of a rapid frozen-section pathological report using the PDCA cycle / 中国基层医药

Objective:To investigate the application value of the PDCA cycle in increasing the rate of timely completion of a rapid frozen-section pathological report.Methods:The basic data of 1 926 rapid frozen section pathological reports not managed by the PDCA cycle in the Department of Pathology, Zhoushan Hospital, during January to August 2019 were collected. The number of pathological reports completed within 30 minutes and the rate of timely completion of pathological reports were calculated and compared with those calculated based on 1 051 pathological reports managed by the PDCA cycle during September to December 2019.Results:After management by the PDCA cycle, the rate of timely completion of frozen-section pathological reports was significantly increased from (84.51 ± 3.61)% to (91.87 ± 1.37)% ( t = 3.86, P < 0.05). Conclusion:Application of the PDCA cycle to pathology management can help monitor the completion of pathological reports on frozen sections. This facilitates determination of reasonable intervention measures and thereby increases the rate of timely completion of pathological reports on frozen sections.

Las perplejidades éticas del Rey Ludwig II de Baviera: locura, extravagancia y profesión médica / The ethical perplexities of king Ludwig II of Bavaria: madness, extravagance and medical profession / As perplexidades éticas do Rei Ludwig II da Baviera: loucura, extravagancia e profissão médica

1. Bernhard von Gudden diagnosticó el trastorno del Rey Ludwig II de Baviera como "paranoia" (locura), aunque Ludwig nunca fue personalmente evaluado por este experto psiquiatra, diagnóstico que usó el gobierno bávaro para justificar la remoción de Ludwig del poder. 2. Su conducta progresivamente anormal; sus proyectos múltiples de construcción, por los cuales incurrió en fuertes deudas; su convicción de descender directamente de los Borbones gracias al "bautismo"; su desenfrenada vida homosexual, todo constituyó la base para el diagnóstico psiquiátrico. 3. De acuerdo con los criterios actuales de la psiquiatría, Ludwig mostró rasgos de un trastorno de personalidad esquizotípico, unido a un sindrome orbitofrontal, y un modo de existencia extravagante. 4. Bernhard von Gudden fundamentó su diagnóstico y peritaje psiquiátricos siguiendo los principios éticos de beneficencia y primum non nocere, "ayudar, al menos no dañar".

Abstract: Bernhard von Guden diagnosed the Bavarian King Ludwig II with "paranoia" (madness), although Ludwig was not personally evaluated by this expert psychiatrist, a diagnosis that the Bavarian government used to justify removing Ludwig from power. 2. His increasingly abnormal behavior, his multiply building projects, for which he incurred much debt, his conviction that he descended from the Bourbons through "baptism", his unbridled homosexual life, together formed the basis for the psychiatrist´s diagnosis. 3. According to modern criteria of psychiatry Ludwig displayed traits for schizotypal personality disorder together with an orbitofrontal syndrome, and an extravagance way of existence. 4.Bernhard von Gudden based his psychiatric diagnosis and expertise following the ethical principles of beneficence and primum non nocere, "to help, at least not to harm"

Resumo: 1. Bernhard von Gudden diagnosticou o transtorno do Rei Ludwig II da Baviera como "paranoia" (loucura), ainda que Ludwig nunca tenha sido pessoalmente avaliado por este especialista psiquiatra, diagnóstico que o governo bávaro usou para justificar a remoção de Ludwig do poder. 2. Sua conduta progressivamente anormal; seus projetos múltiplos de construção, pelos quais incorreu em fortes dívidas; sua convicção de descender diretamente dos Bourbons graças ao "batismo"; sua desenfreada vida homossexual, tudo constituiu a base para o diagnóstico psiquiátrico. 3. De acordo com os critérios atuais da psiquiatria, Ludwig mostrou traços de um transtorno de personalidade esquizotípico, unido a uma síndrome órbito-frontal e um modo de existência extravagante. 4. Bernhard von Gudden fundamentou seu diagnóstico e perícia psiquiátrica seguindo os princípios éticos de beneficência e primum non nocere, "ajudar, ao menos não prejudicar".

The impact of COVID-19 in medical practice. A review focused on Urology

ABSTRACT COVID-19 pandemic is a rapidly spreading virus that is changing the World and the way doctors are practicing medicine. The huge number of patients searching for medical care and needing intensive care beds led the health care system to a burnout status especially in places where the care system was already overloaded. In this setting, and also due to the absence of a specific treatment for the disease, health authorities had to opt for recommending or imposing social distancing to relieve the health system and reduce deaths. All other medical specialties nondirectly related to the treatment of COVID-19 had to interrupt or strongly reduce their activities in order to give room to seriously ill patients, since no one knows so far the real extent of the virus damage on human body and the consequences of doing non deferrable procedures in this pandemic era. Despite not been a urological disease, the urologist needs to be updated on how to deal with these patients and how to take care of himself and of the medical team he works with. The aim of this article is to review briefly some practical aspects of COVID-19 and its implications in the urological practice in our country.

Establishment and application of networked full-coverage multi-disciplinary team management mode under hospital administrative guidance / 中华医院管理杂志

Multi-disciplinary team(MDT)mode is regarded as the key to standardized diagnosis and treatment of malignant tumors. The model, however, encounters such roadblocks in the current form of MDT organization, as costly clinical resources and time consumption, low efficiency, poor management of participating experts in MDT, and lack of enforceability of the therapeutic decisions made. This paper summarized the practical MDT experiences of the Affiliated Cancer Hospital of Shandong First Medical University. It introduced the construction of an intranet-based MDT system covering a large proportion of newly diagnosed malignant tumor patients, and the practices and achievements of such MDT management system under hospital administrative guidance. The authors proposed to use reporting ratio as the main assessment indicator in promoting MDT, and that to define the performance, responsibilities and rights in MDT practice. These measures aim at to upgrading individual behaviors of doctors to organizational behaviors of hospitals, and providing cancer patients with more standardized, comprehensive and personalized diagnosis and treatment decisions.

Current setup and insights of the practicing scope of physicians in China / 中华医院管理杂志

Objective:To analyze the setup basis and registration rules of the practice scope of physicians in China, and take into account the current situation of individual provinces, for suggestions on further revision of the practice scope of these physicians.Methods:Relevant documents on practice scope setup were retrieved from such databases as CNKI, Wanfang and Weipu databases, while relevant national policies, laws and regulations were reviewed. On-site visits were conducted to health committees and medical institutions in 7 provinces from June 2020 through December 2020. Seminars and special interviews were held with relevant management personnel and doctors of different positions, for the purpose of learning the current physician practice scope setup and their suggestions for reform. Data gained from the above methods were summarized to arrive at reform suggestions for optimizing China′s practice scope setup, with further improvement made based on expert consultation method.Results:Several setbacks were found in the setup of their practice scope in China, namely as unclear setup principles, generalized setup of the national standards, inconsistent setup standards among the provinces, prohibition of cross-category registration, and roadblocks against in changing scope of practice. As the setup of the practice scope should set free manpower, unleash vitality, and delegate power, the practice scope should be changed to three categories of " discipline" , " discipline+ technology" and " comprehensive" . Physicians should be entitled to register separately as " discipline" and " discipline+ technology" as their practice scope, with " comprehensive" practice scope approved by a simple procedure of a notice.Conclusions:The setup and modification of the practice scope should be in a general rather than detailed manner, and conducive to the development of related disciplines. Such measures should also fully unleash the vitality of Chinese physicians, and take into account of both peacetime and emergencies, and both medical service and prevention.

Current setup and insights of the diagnosis and treatment subjects in medical institutions in China / 中华医院管理杂志

Objective:To study the current setup of diagnosis and treatment subjects in China and make reform suggestions in light of existing problems.Methods:Relevant documents on medical institutions′ diagnosis and treatment subjects setup were retrieved from such databases as CNKI, Wanfang and Weipu database, while relevant national policies, laws and regulations were reviewed. On-site visits were conducted to health committees and medical institutions in 7 provinces from June 2020 through December 2020. Seminars and special interviews were held with relevant management personnel and doctors of different positions, for the purpose of learning the current medical institutions′ diagnosis and treatment subjects and their suggestions for reform. Data gained from the above methods were summarized to arrive at reform suggestions for optimizing China′s medical institutions′ diagnosis and treatment subjects, with further improvement made based on expert consultation method.Results:Problems found focus on such areas as inconsistent setup standards for medical treatment subjects, multiple overlapping services, and unclear numbering rules. Based on the disease list and skill list of the DRG system, a novel diagnosis and treatment subject setup method guided by service items could be established. Otherwise, the numbering and categories could changed on the current basis to correct existing problems. The subjects could be divided into such five categories as clinical, oral, traditional Chinese medicine, medical technology, and comprehensive, with level-1 and level-2 subjects set up respectively.Conclusions:In terms of subject functions, the setup of diagnosis and treatment subjects should be regularly adjusted or filed, instead of complete equivalence with administratively licensed subjects. As the current setup of diagnosis and treatment subjects had been in place for years, and had become key references for the department setup and performance appraisal of medical institutions, it was proposed to make adjustment on the current basis for the purpose of correcting existing problems.

Is Follow-up of Adrenal Incidentalomas Always Mandatory?

Adrenal masses are mainly detected unexpectedly by an imaging study performed for reasons unrelated to any suspect of adrenal diseases. Such masses are commonly defined as “adrenal incidentalomas” and represent a public health challenge because they are increasingly recognized in current medical practice. Management of adrenal incidentalomas is currently matter of debate. Although there is consensus on the need of a multidisciplinary expert team evaluation and surgical approach in patients with significant hormonal excess and/or radiological findings suspicious of malignancy demonstrated at the diagnosis or during follow-up, the inconsistency between official guidelines and the consequent diffuse uncertainty on management of small adrenal incidentalomas still represents a considerable problem in terms of clinical choices in real practice. The aim of the present work is to review the proposed strategies on how to manage patients with adrenal incidentalomas that are not candidates to immediate surgery. The recent European Society of Endocrinology/European Network for the Study of Adrenal Tumors guidelines have supported the view to avoid surveillance in patients with clear benign adrenal lesions <4 cm and/or without any hormonal secretion; however, newer prospective studies are needed to confirm safety of this strategy, in particular in younger patients.

New opportunity of management strategy of diagnosis and treatment of chronic wound: emerging technology / 中华烧伤杂志

Along with the development of society and the change of disease spectrum, chronic wound is gradually becoming the core of burn and plastic surgery field. Although there have been some progresses in the diagnosis and treatment technology, the management strategy of chronic wound is still in the traditional mode stage. The development of internet of things, cloud computing, big data, artificial intelligence, and other emerging technologies is changing with each passing day, and they have rapidly penetrated into the health care field. To explore the application prospect of emerging technology in the diagnosis and treatment management of chronic wound and to plan its strategy and mode in the diagnosis and treatment of chronic wound can further promote development of discipline of burns.

Effect of health management mode of chronic disease on management of hypertension patients / 中国基层医药

Objective@#To analyze the effect and clinical value of the health management model of hypertension and chronic diseases developed by the health management center.@*Methods@#From June 2015 to June 2018, 550 patients with hypertension were selected in Taizhou Central Hospital and Taizhou Hospital.According to the management of chronic health point, the patients were divided into two groups, with 275 cases in each group.The patients before the chronic disease health management (from June 2015 to January 2017) were selected as control group, and the patients after implementing the health management of chronic disease (from February 2017 to June 2018) were selected as observation group.The standard blood pressure and blood fat were compared between the two groups.@*Results@#The compliance rate of blood pressure in the observation group was 61.09%, which was significantly higher than 34.91% in the control group, and the difference between the two groups was statistically significant(χ2=6.012, P<0.05). After intervention, the triglycerides [(1.47±0.21)mmol/L], total cholesterol[(4.61±0.51)mmol/L], and low-density lipoprotein [(2.76±0.22)mmol/L] in the observation group were significantly different with those in the control group (t=5.991, 6.398, 8.128, all P<0.05). After intervention, the body mass index [(24.32±1.88)kg/m3] and waist circumference [(83.26±6.03)cm] in the observation group were significantly different with those in the control group (t=5.928, 7.489, all P<0.05).@*Conclusion@#The model of health management for chronic diseases developed by the health management center can improve blood pressure and blood lipids of people who have physical examination, and provide effective health guidance services for patients with hypertension, which is worthy of further promotion in clinical practice.

Effect of health management mode of chronic disease on management of hypertension patients / 中国基层医药

Objective To analyze the effect and clinical value of the health management model of hypertension and chronic diseases developed by the health management center.Methods From June 2015 to June 2018,550 patients with hypertension were selected in Taizhou Central Hospital and Taizhou Hospital .According to the management of chronic health point,the patients were divided into two groups ,with 275 cases in each group.The patients before the chronic disease health management (from June 2015 to January 2017) were selected as control group ,and the patients after implementing the health management of chronic disease (from February 2017 to June 2018) were selected as observation group.The standard blood pressure and blood fat were compared between the two groups .Results The compliance rate of blood pressure in the observation group was 61.09%,which was significantly higher than 34.91%in the control group,and the difference between the two groups was statistically significant (χ2 ＝6.012,P＜0.05). After intervention,the triglycerides [( 1.47 ±0.21) mmol／L], total cholesterol [( 4.61 ±0.51 ) mmol／L], and low－density lipoprotein [(2.76 ±0.22)mmol／L] in the observation group were significantly different with those in the control group ( t ＝5.991,6.398,8.128,all P＜0.05).After intervention,the body mass index [( 24.32 ± 1.88)kg／m3] and waist circumference [(83.26 ±6.03) cm] in the observation group were significantly different with those in the control group (t＝5.928,7.489,all P＜0.05).Conclusion The model of health management for chronic diseases developed by the health management center can improve blood pressure and blood lipids of people who have physical examination ,and provide effective health guidance services for patients with hypertension ,which is worthy of further promotion in clinical practice.

El sentido social del profesionalismo médico / The social meaning of medical professionalism

Se examina el significado actual del profesionalismo y la aparente inconsistencia entre el crecimiento de su demanda, el contexto de profundos cambios y la insatisfacción con la práctica médica. Se revisa el clima cultural de nuestro tiempo como entorno indispensable para comprender los cambios acontecidos en la organización social de la medicina. Uno de los rasgos críticos de las profesiones ha sido el poder de manejar el conocimiento especializado según parámetros propios y sin control externo. Los límites de esta autorregulación pericial se han diluido y representan una amenaza importante para el profesionalismo. Junto con cambios fundamentales y tensiones en las condiciones de laborales, la demanda de profesionalismo ha crecido. El profesionalismo puede contribuir a estabilizar los sistemas sociales como una tercera lógica instalada entre el mercado y las organizaciones públicas pues goza de la capacidad de someter a los intereses colectivos el individualismo devastador. El profesionalismo como un sistema basado en valores e ideología surge como respuesta a los desafíos planteados a la práctica de la medicina. Representa reflexiones y preservación de valores tradicionales que inspiran una práctica de excelencia y que sin duda restaurará y mejorará la confianza pública en la medicina.

This essay looks into the meaning of today's professionalism and the apparent inconsistency between its growing status and a context of profound changes and dissatisfaction with medical practice. The cultural climate of our times is reviewed, as the framework for understanding changes in the social organization of medicine. One of the critical traits of professions has been their power to manage specialized knowledge under their own standards, without external control. The limits of this self regulation of expertise have faded, representing an important threat for professionalism. Together with the fundamental changes and tensions of work conditions for professionals, however, the appeal of professionalism is on the rise. Because of its ability to submit devastating individualism to collective interests, professionalism can contribute to the stability of social systems, as a third logic, between the market and public organizations. In medicine, professionalism as a value based system and ideology, also emerges as a response to the challenges posed to its practice. It represents reflection and preservation of traditional values inspiring a practice of excellence, which will undoubtedly restore and enhance public confidence in medicine.

Examina-se o significado atual do profissionalismo e a aparente inconsistência entre o crescimento de sua exigência, o contexto de profundas mudanças e a insatisfação com a prática médica. Confere-se o clima cultural de nosso tempo como contexto indispensável para compreender as mudanças acontecidas na organização social da medicina. A possibilidade de operar com conhecimento especializado, segundo parâmetros próprios e sem controle externo tem sido um dos problemas das profissões. Os limites desta autorregulação pericial se têm dissolvido e representam una ameaça importante para o profissionalismo. Junto com mudanças fundamentais e tensões nas condições de trabalho, tem crescido a procura de profissionalismo. Este pode contribuir a estabilizar os sistemas sociais como una terceira lógica instalada entre o mercado e as organizações públicas uma vez que goza é capaz de submeter o individualismo devastador aos interesses coletivos. Profissionalismo como um sistema baseado em valores e ideologia responde aos desafios colocados à prática da medicina. Representa pensamento e preservação de valores tradicionais que inspiram uma prática de excelência e que sem sombra de dúvidas vai recuperar e melhorar a confiança pública na medicina.

Clinical effect of enhanced recovery after surgery management in patients with vaginal hysterectomy / 中国基层医药

Objective@#To analyze the effect of enhanced recovery after surgery program(ERAS) in perioperative management of vaginal hysterectomy.@*Methods@#The clinical data of 73 patients who underwent transvaginal hysterectomy for uterine fibroids, adenomyosis, middle pelvic defects, cervical lesions and endometrial lesions were retrospectively analyzed.All patients were divided into two groups according to the perioperative management method.The observation group (35 cases) received the enhanced recovery program, while the control group (38 cases) received the routine perioperative management.The general data and perioperative management indicators of the two groups were recorded and compared.@*Results@#There were no statistically significant differences between the two groups in mean age, body mass index, abdominal surgery history and diagnosis constitution(all P>0.05). The first feeding time[(7.6±1.3)h vs.(12.6±3.2)h], postoperative exhaust time[(15.5±4.6)h vs.(20.2±6.5)h], indwelling catheter time[(20.1±4.9)h vs.(28.4±6.8)h], mobilization time[(19.2±3.5)h vs.(24.2±7.9)h], the length of hospital stay[(4.5±0.7)d vs.(5.8±1.2)d]and hospitalization expense[(6 545.2±430.7)CNY vs.(7 953.8±653.3)CNY]of the observation group were less than those of the control group, the differences were statistically significant(t=8.069, 3.538, 5.938, 3.582, 5.590, 10.777, all P<0.05). There were no statistically significant differences between the two groups in the operation time[(45.3±20.8)min vs.(39.9±17.4)min]and the amount of bleeding[(69.4±32.2)mL vs.(57.0±24.5)mL](t=0.231, 0.067, all P>0.05).@*Conclusion@#The ERAS program perioperative management can speed up the postoperative recovery process, reduce the length of hospital stay and the financial burden of patients who underwent transvaginal hysterectomy.

Association between participation and compliance with Continuing Medical Education and care production by physicians: a cross-sectional study / Associação entre participação e cumprimento de um programa de Educação Médica Continuada e produção assistencial dos médicos: estudo transversal

Objective Physician participation in Continuing Medical Education programs may be influenced by a number of factors. To evaluate the factors associated with compliance with the Continuing Medical Education requirements at a private hospital, we investigated whether physicians’ activity, measured by volumes of admissions and procedures, was associated with obtaining 40 Continuing Medical Education credits (40 hours of activities) in a 12-month cycle. Methods In an exclusive and non-mandatory Continuing Medical Education program, we collected physicians’ numbers of hospital admissions and numbers of surgical procedures performed. We also analyzed data on physicians’ time since graduation, age, and gender. Results A total of 3,809 credentialed, free-standing, private practice physicians were evaluated. Univariate analysis showed that the Continuing Medical Education requirements were more likely to be achieved by male physicians (odds ratio 1.251; p=0.009) and who had a higher number of hospital admissions (odds ratio 1.022; p<0.001). Multivariate analysis showed that age and number of hospital admissions were associated with achievement of the Continuing Medical Education requirements. Each hospital admission increased the chance of achieving the requirements by 0.4%. Among physicians who performed surgical procedures, multivariate analysis showed that male physicians were 1.3 time more likely to achieve the Continuing Medical Education requirements than female physicians. Each surgical procedure performed increased the chance of achieving the requirements by 1.4%. Conclusion The numbers of admissions and number of surgical procedures performed by physicians at our hospital were associated with the likelihood of meeting the Continuing Medical Education requirements. These findings help to shed new light on our Continuing Medical Education program. .

Objetivo A participação de médicos em programas de Educação Médica Continuada pode ser influenciada por inúmeros fatores. Para avaliar os fatores associados ao cumprimento dos requisitos para Educação Médica Continuada em um hospital privado, investigamos se a atividade médica, medida por volume de internações e procedimentos, esteve relacionada à obtenção de 40 créditos (40 horas-aula) em um ciclo do programa de 12 meses. Métodos Em um programa exclusivo e não obrigatório de Educação Médica Continuada, coletamos o número de admissões e de procedimentos realizados por médico. Analisamos dados como tempo de formado, idade e sexo. Resultados Foram analisados dados de 3.809 médicos credenciados e autônomos. A análise univariada mostrou que os requisitos de Educação Médica Continuada eram mais preenchidos por médicos do sexo masculino (odds ratio de 1,251; p=0,009) e que eles apresentavam números de internações mais significativos (odds ratio de 1,022; p<0,001). A análise multivariada mostrou que idade e número de admissões estiveram associados ao cumprimento das metas estabelecidas. Cada admissão aumentou a chance de atingir a meta em 0,4%. Entre os que realizaram procedimentos cirúrgicos, a análise multivariada mostrou que médicos do sexo masculino eram 1,3 vez mais propensos a atingir a meta estabelecida que seus pares do sexo feminino. Cada procedimento cirúrgico realizado elevou a chance de atingir a meta em 1,4%. Conclusão O número de admissões e de procedimentos cirúrgicos realizados por médicos em nosso hospital foi associado à probabilidade de alcançar a meta de Educação Médica Continuada. Estes achados lançaram uma nova luz sobre o nosso programa de Educação Médica Continuada. .

Rational use of blood calcium determinations / Uso racional da dosagem de cálcio no sangue

CONTEXT AND OBJECTIVE: This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo (HCFMUSP). Its aim was to suggest rules for the determination of total and ionized calcium in our intensive care units, emergency department, wards and outpatient services, thus contributing towards improving the quality of medical care and achieving more appropriate use of human and financial resources. DESIGN AND SETTING: Critical analysis on clinical and laboratory data and the pertinent scientific literature, conducted by the study group for rational clinical laboratory use, which is part of the Central Laboratory Division, HCFMUSP. METHODS: The study group reviewed scientific publications, statistics and clinical and laboratory data concerning requests for total and ionized calcium determinations in the settings of intensive care units, emergency department, wards and outpatient services. RESULTS: From this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed. CONCLUSIONS: Use of the proposed flow diagrams may help to limit the numbers of inappropriate requests for ionized and total calcium determinations, with consequent reductions in the number of tests, risks to patients and unnecessary costs. .

CONTEXTO E OBJETIVO: Este trabalho foi motivado pelo recente aumento excessivo de solicitações de dosagem de cálcio no sangue, assim como de exames laboratoriais em geral, no complexo do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Seu objetivo foi sugerir regras para a determinação de cálcio total e iônico nas nossas unidades de terapia intensiva, pronto-socorro, enfermarias e ambulatórios e contribuir para a melhoria da qualidade da assistência médica, com utilização mais adequada dos recursos humanos e financeiros. TIPO DO ESTUDO E LOCAL: Análise crítica de dados clínicos, laboratoriais e da literatura médica pertinente, realizada pelo grupo de estudos para o uso racional do laboratório clínico, vinculado à Divisão de Laboratório Central do HCFMUSP. MÉTODOS: O grupo de estudos reviu publicações científicas, estatísticas e dados clínico-laboratoriais relativos às solicitações de cálcio total e iônico nos ambientes das unidades de terapia intensiva, prontos-socorros, enfermarias e ambulatórios. RESULTADOS: A partir dessa análise crítica, foram construídos fluxogramas de decisão clínica que visam orientar a requisição desses testes. CONCLUSÕES: A utilização dos fluxogramas propostos pode ajudar a limitar a solicitação inadequada das dosagens de cálcio total e iônico, com consequente redução do número de exames, de riscos para os pacientes e de custos desnecessários. .

Considerações sobre eficiência administrativa relacionado aos exames de ultra-sonografia, tomografia computadorizada e ressonância magnética nas afecções orbitárias / Reasons for the administrative efficiency related to ultrassonography, computed tomography and magnetic resonance imaging tests in orbital diseases

OBJETIVOS: Enfocar os exames de ultra-sonografia (US), tomografia computadorizada (TC) e ressonância magnética (RM), levantando, revisando e discutindo as seguintes medidas na melhoria da eficiência destes procedimentos na órbita: 1- Defasagem dos honorários médicos; 2- Vantagens e desvantagens dos exames; 3- Diretrizes clínicas. MÉTODOS: No período de julho de 2002 a março de 2003, realizou-se um levantamento dos valores dos exames orbitários de US, TC e RM pagos pelo Sistema Único de Saúde - SUS, operadoras de planos e seguros de saúde e particulares cobrados em três clínicas oftalmológicas e três clínicas radiológicas referenciadas. Pesquisa bibliográfica e revisão na literatura dos referidos exames e suas diretrizes clínicas nas afecções orbitárias. RESULTADOS: 1- Valores dos exames em reais (R$): US: 9,05 - SUS / 81,77 - AMB 90 / 57,01 - AMB/CIEFAS 93 / 102,00 - AMB/LPM 99 / 158,33 - particular. TC: 86,76 - SUS / 193,70 - AMB 90 / 196,30 - AMB/CIEFAS 93 / 204,12 - AMB/LPM 99 / 255,33 - particular. RM: 268,75 - SUS / 475,80 - AMB 90 e AMB/CIEFAS 93 / 472,50 - AMB/LPM 99 / 563,33 - particular; 2- Vantagens e desvantagens dos exames descritos de acordo com a revisão da literatura; 3- As doenças da órbita não têm ainda listadas suas diretrizes. CONCLUSÃO: Estes exames são os mais utilizados e consagrados pela sua eficácia no estudo da órbita. Para uma maior eficiência, devemos considerar as seguintes recomendações administrativas: 1- Modernização e atualização das tabelas de honorários com índices mínimos e mais justos na remuneração dos exames com reembolso dos insumos utilizados como filmes radiológicos e contrastes: 2- Promover e estimular a educação médica continuada, evitando o excesso de exames desnecessários ou inapropriados: 3- Elaboração e implementação de diretrizes e protocolos clínicos baseados em evidências nas principais doenças orbitárias que possam ser utilizados como referência.

PURPOSES:This study focuses the orbital exams of ultrassononography (US), computed tomography (CT) and magnetic resonance imaging (MRI), and has the following purposes: Collecting the paid amounts by Sistema Único de Saúde (SUS), Associação Médica Brasileira (AMB) and private clinic tables. Reviewing the advantages and disadvantages of the referred diagnostic tests. Suggesting administrative efficiency measures related to these tests in the orbit. METHODS: The costs were achieved based on the amounts paid by SUS, brazilian medical insurance companies and private clinics in Rio de Janeiro City. Bibliographic research of the advantages and disadvantages of these tests. RESULTS: Amounts of these tests in reais (R$): US: 9,05 SUS / 81,77 AMB 90 / 57,01 AMB/CIEFAS 93 / 102,00 AMB/LPM 99 / 158,33 private clinics. CT 86,76 SUS / 193,70 AMB90 / 196,30 AMB/CIEFAS 93 / 204,12 AMB/LPM 99 / 255,33 private clinics MRI: 268,75 SUS / 475,80 AMB 90 and AMB/CIEFAS 93 / 472,50 AMB/LPM 99 / 563,33 private clinics. The advantages and disadvantages of these tests were described according to the literature review. CONCLUSION: Knowing the tests costs and its advantages and disadvantages are important strategies to improve efficiency in diagnostic imaging. It was also concluded the need of new clinical studies that includes economic evaluation of cost-effectiveness in US, CT and MRI exams in orbital diseases which allow the development of clinical practice guidelines or clinical protocols to be applied in medical and administrative decision making.