Partial Left Ventriculectomy: Have Well-Succeeded Cases and Innovations in the Procedure Been Observed in the Last 12 Years?

ABSTRACT OBJECTIVE: In 1996, the Brazilian cardiovascular surgeon, Dr. Randas Batista, introduced a surgical technique called partial left ventriculectomy, where he admitted the possibility of reducing the diameter of the left ventricle through the sectioning of one section of its wall. After the publication of this study, thousands of case reports and procedure analysis have been published, and due to several disappointing results, many doctors and institutions failed to execute it. As the main objective of this study, stands out the search for success cases of ventriculectomy in the last 12 years and if during this period it was achieved some significant development in this procedure that allows obtaining lower mortality rate postoperatively. METHODS: Systematic review of indexed scientific literature over the past 12 years and the term "Partial Left Ventriculectomy". RESULTS: There has been a considerable number of reported successful cases and highly significant findings in regard to determining the most suitable region for the section, proper selection of the patients indicated to the procedure, including the influence of the coronary artery anatomy in the nomination procedure and the need for preservation of ventricular geometry to ensure better quality of ventricular contractions after the sectioning. CONCLUSION: This surgical procedure has been successfully performed, mainly in Japan, improvements in its efficiency were found and the need for a mathematical modeling of the slice to be severed is a prominent factor in many studies.

Cuba: healthcare and the revolution / Cuba: la atención a la salud y la revolución

This paper depicts Cuba as a relic of the Cold War. Its coverage of healthcare demonstrates steadfastness and success in surmounting hurdles of complacency and disregard to socialized medicine - an extension of Soviet patronage and third world alliances. The literature relays a mission of inclusivity underpinned by political ideology and a conviction to humanity. With the aid of endorsements, it speaks to contrasts and critiques in service and results by reflecting on the delivery of free healthcare for all Cuban citizens and its impression on the eradication of numerous diseases, reduced mortality rate and increased life expectancy. Punished by the longest trade embargo in modern history, the regime is in possession of limited resources to expedite remedy to its subjects. Such, much to the dislike of the authorities, elevates elements of distinction in association with the dispensation of service and drugs demonstrated by an evolving twotier system for the disenfranchised and privileged clientele while simultaneously impacting the maintenance of facilities and equipment. Consequently, it recognizes harsh ramifications attributed to compliance with ideology and subtle adjustments to withstand external exertion. The Cuban replica is currently a tale of sorts awaiting a comprehensible definition for future generations.

Este trabajo describe a Cuba como una reliquia de la guerra fría. Su discusión en torno a la atención de la salud demuestra firmeza y éxito en la superación de los obstáculos provenientes de la autocomplacencia e indiferencia frente a la "medicina socializada" - una extensión del apoyo soviético y las alianzas del tercer mundo. La literatura transmite una misión de inclusión apuntalada por ideología política y una convicción de humanidad. Con documentación de apoyo, el trabajo se refiere a los contrastes y críticas del servicio y los resultados, reflexionando sobre los servicios de atención médica gratuita para todos los ciudadanos cubanos. Asimismo expone su impresión sobre la erradicación de numerosas enfermedades, la disminución de la tasa de mortalidad, y el aumento de la esperanza de vida. Castigado por el embargo comercial más largo de la historia moderna, el régimen se halla en posesión de limitados recursos para ofrecer soluciones a los ciudadanos. Para pesar de las autoridades, estas cosas aumentan los elementos de diferenciación asociados con el ofrecimiento de servicios y medicamentos, demostrada por un sistema que se va desarrollando en dos planos - los carentes de privilegios frente a una clientela privilegiada - en tanto que a su vez se hace sentir el impacto sobre el mantenimiento de las instalaciones y los equipos. Por consiguiente, el trabajo reconoce las duras ramificaciones que se atribuyen al cumplimiento con la ideología y los sutiles ajustes para resistir la presión externa. El modelo cubano es actualmente una suerte de historia en espera de una definición comprensible para las generaciones futuras.

Organización y financiamiento del sistema de salud en la Argentina / The Argentine Health System: Organization and financial features

El sistema de salud argentino se caracteriza por los siguientes rasgos: a) la organización federal del país, donde las provincias se encargan de administrar salud y educación; b) coexistencia de servicios públicos y privados, tanto ambulatorios como de internación; c) entidades fragmentadas de seguridad social, en su mayoría de origen extra-estatal. Se describen y se calculan los componentes del sistema; se analiza la distribución del poder de decisión entre la autoridad sanitaria nacional y las provinciales y se comparan con la organización de otros países. Se muestran datos estadísticos sobre distribución del gasto en salud y cobertura de servicios en la población. Asimismo se presentan flujos financieros entre las diversas fuentes de recursos, aseguradores, prestadores y los usuarios de cada sector.

The Argentine health system is defined by the following features: a) federal country organization; b) coexistence of public and private services with either outpatients or inpatients; c) fragmented entities of social security, most of these originated outside of the state organization. Components of the system are described and weighed; making decisions strength between national and provincial health authorities is analyzed and the Argentine system is compared with that of other countries. Statistical data on distribution of health expenditures and coverage of health services are presented as well as financial flow among diverse funding sources, insurers, providers and users of each sector.

Sistema de salud de Cuba / The health system of Cuba

En este trabajo se describen las condiciones de salud de Cuba y el sistema cubano de salud, incluyendo su estructura y cobertura, sus fuentes de financiamiento, su gasto en salud, los recursos físicos, materiales y humanos de los que dispone, y las actividades de rectoría e investigación que desarrolla. También se discute la importancia de sus instituciones de investigación y se describe el papel de los usuarios de los servicios en la operación y evaluación del sistema, así como las actividades que en este sentido desarrollan la Federación de Mujeres Cubanas y los Comités de Defensa de la Revolución. La parte final de este trabajo se dedica a discutir las innovaciones más recientes dentro de las que destacan las redes de cardiología, la Misión Milagro y la Batalla de Ideas.

This paper describes the health conditions in Cuba and the general characteristics of the Cuban health system, including its structure and coverage, its financial sources, its health expenditure, its physical, material and human resources, and its stewardship functions. It also discusses the increasing importance of its research institutions and the role played by its users in the operation and evaluation of the system. Salient among the social actors involved in the health sector are the Cuban Women Federation and the Committees for the Defense of the Revolution. The paper concludes with the discussion of the most recent innovations implemented in the Cuban health system, including the cardiology networks, the Miracle Mission (Misión Milagro) and the Battle of Ideas (Batalla de Ideas).

Governança local no sistema descentralizado de saúde no Brasil / Local governance in the decentralized health care system in Brazil

OBJETIVO: Analisar as mudanças decorrentes do processo de descentralização do Sistema Único de Saúde na governança do setor saúde no âmbito do poder local entre 1996 e 2006. MÉTODOS: Um questionário foi aplicado aos gestores municipais de saúde de todo o Brasil em 1996 e novamente em 2006. Foram coletadas informações sobre as características de inovação da gestão em três dimensões: social, gerencial e assistencial. O presente artigo analisa resultados referentes à dimensão social da gestão (relação entre a gestão municipal e os diferentes atores da sociedade) a partir de quatro atributos: elaboração do orçamento (qual o grau de influência de atores variados), estabelecimento de prioridades, prestação de contas e fluxo de informações para a sociedade. RESULTADOS: Aumentou a influência dos secretários e dos conselhos municipais de saúde na elaboração do orçamento, em detrimento da influência dos políticos locais. Na definição de prioridades em saúde, reduziu-se a solicitação dos políticos locais e a demanda espontânea e fortaleceram-se o parecer do corpo técnico e as propostas dos conselhos e das conferências de saúde. Observa-se a institucionalização da prática de prestação de contas em virtude da diversificação do conjunto de atores a que se direciona (especialmente câmara de vereadores e conselho de saúde) e dos mecanismos utilizados, embora continue prevalecendo o uso de balancete periódico (que implica em conhecimento técnico para interpretação dos resultados). Por fim, as informações oferecidas à população ainda se referem acima de tudo às ações e campanhas de saúde e ao funcionamento de serviços, embora tenha crescido a divulgação de informações inovadoras à sociedade. Esse padrão se observa em todas as regiões e portes populacionais, com tendências mais progressivas na região Sul. CONCLUSÕES: A relação entre estado e sociedade modificou-se em direção a um padrão mais democrático de governança local, embora tenham sido mantidas práticas governamentais concentradoras de poder na tomada de decisão. O processo de descentralização ainda encontra obstáculos importantes para a concretização de um modelo de maior participação, controle social, responsabilização e interação entre Estado e sociedade.

OBJECTIVE: To analyze the changes in local health care governance resulting from the decentralization process associated with the Unified Health System (SUS) in Brazil between 1996 and 2006. METHODS: A questionnaire was answered in 1996 and again in 2006 by all city officials involved in health care management in Brazil. Information was collected on the innovative characteristics of administrative practices in terms of three dimensions: social, management, and care. The present article analyzes the results relating to the social dimension (relationship between municipal officials and the various community actors) according to four attributes: preparing the budget (degree of influence of various actors), establishing priorities, accountability, and flow of information to the community. RESULTS: The influence of municipal secretaries of health and health councils on budget preparation has increased, with a decrease of local politician influence. In prioritizing health issues, local politicians and spontaneous demands have also become less influential, with strengthening of the influence of technical opinions and proposals by health councils and conferences. Public disclosure of results has become institutionalized as a result of the diversification of stakeholders (especially municipal secretaries and health councils) and of the methods available for disclosure, even though balance sheets are still the most common type of information disclosed (which imply technical knowledge for interpretation of results). Finally, the information conveyed to the community still mainly refers to health actions and campaigns and functioning of health services, even though a larger amount of innovative information is being communicated. This was observed in all regions and in cities of all sizes, with a more progressive trend in the South of Brazil. CONCLUSIONS: The relationship between government and society has changed toward a more democratic standard of local governance, despite the maintenance of centralized government decision-making practices. The process of decentralization still faces important obstacles to the establishment of a more participative model, with enhanced social control, accountability and interaction between government and society.

Participation Determinants in the DRG Payment System of Obstetrics and Gynecology Clinics in South Korea / 예방의학회지

OBJECTIVES: The Diagnosis Related Group (DRG) payment system, which has been implemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. METHODS: The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. RESULTS: The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (p<0.05): (1) a larger number of caesarian section (c/sec) claims, (2) higher cost of a c/sec, (3) less variation in the price of a c/sec, (4) fewer days of admission for a c/sec, and (5) younger pregnant women undergoing a c/sec. CONCLUSIONS: These results suggest that OBGYN clinics with an economic practice pattern under a fee-for-service system are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.

Surtimiento de recetas a los afiliados al Seguro Popular de Salud de México / Dispensing prescriptions to persons affiliated with Popular Health Insurance in Mexico

OBJETIVO: Medir y comparar el porcentaje de recetas surtidas completamente a los usuarios de servicios ambulatorios y de los hospitales generales de los Servicios Estatales de Salud de México (SESA) afiliados y no afiliados al Seguro Popular de Salud (SPS) según condición de aseguramiento, además de medir la satisfacción de los usuarios de los SESA con el acceso a los medicamentos. MATERIAL Y MÉTODOS: La información del estudio procede de cuatro encuestas de unidades ambulatorias y hospitalarias de los SESA que contaron con muestras probabilísticas de representatividad estatal. Las muestras de las unidades ambulatorias se seleccionaron mediante estratificación por nivel de atención y por condición de pertenencia a la red de servicios del SPS. RESULTADOS: Los hallazgos indican que el porcentaje de recetas completamente surtidas ha mejorado en las unidades ambulatorias de los SESA, sobre todo en aquellas que ofrecen servicios a los afiliados al SPS y que alcanzan porcentajes de casi 90 por ciento. Estos porcentajes, sin embargo, siguen siendo inferiores a los de las unidades ambulatorias de las instituciones de seguridad social. Los porcentajes de recetas surtidas en las unidades hospitalarias de los SESA también han mejorado, pero siguen siendo relativamente bajos. En casi todas las entidades federativas, conforme se ha incrementado el porcentaje de surtimiento completo de recetas, ha aumentado la satisfacción de los usuarios con el acceso a los medicamentos. CONCLUSIONES: En 2006, más de 50 por ciento de las entidades federativas presentaron altos niveles de surtimiento completo de recetas entre los afiliados al SPS (>90 por ciento). El mayor problema en este sentido se encuentra en los hospitales, ya que sólo 44 por ciento de los usuarios que recibieron una prescripción en los hospitales de los SESA en 2006 obtuvieron el surtimiento completo de sus recetas. Este hallazgo obliga a revisar la política de medicamentos del SPS, que ha privilegiado...

OBJECTIVE: Measure and compare the percentage of prescriptions fully dispensed to persons with and without Popular Health Insurance (SPS in Spanish) who use ambulatory and general hospital services associated with the Mexico State Health Services (SESA in Spanish), and taking into account insurance status. SESA user satisfaction was also measured with respect to access to medication. MATERIAL AND METHODS: Information for the study was taken from four surveys of SESA ambulatory and hospital units that included probabilistic samples with state representativity. Samples of ambulatory units were selected by stratification according to level of care and association to the SPS service network. RESULTS: The findings indicate that the percentage of prescriptions fully dispensed in SESA ambulatory units has improved, reaching approximately 90 percent, especially among those units offering services to persons affiliated with SPS. Nevertheless, these percentages continue to be lower than those of ambulatory units associated with social security institutions. Percentages of prescriptions fully dispensed have also improved in SESA hospital units, but continue to be relatively low. In nearly all states, as the percentage of prescriptions fully dispensed has increased, user satisfaction with access to medication has also improved. CONCLUSIONS: In 2006 more than 50 percent of the states had high levels of fully dispensed prescriptions among persons with SPS (>90 percent). The more significant problem exists among hospitals, since only 44 percent of users who received a prescription in SESA hospitals in 2006 had their prescriptions fully dispensed. This finding requires a review of SPS medication policies, which have favored highly prescribed low-cost medications at ambulatory services at the expense of higher cost and more therapeutically effective medications for hospital care, the latter having a greater impact on household budgets.