Business performance management in university hospitals: a diagnosis in Brazilian institutions / Evaluación del desempeño empresarial en hospitales universitarios: un diagnóstico en las instituciones brasileñas

ABSTRACT Objectives To investigate whether business performance management practices are used by Brazilian federal university hospitals, and if so, to determine which practices are used and explore characteristics that may be related to their adoption. Method Descriptive ex post facto research on the effects of the studied variables in relation to the technical procedures. Secondary data and survey resources were used. Results Four hospitals use practices to assess business performance. Three of them stated that they use two different types of practices and that 75 % of university hospitals with at least one business performance management practice also have a strategic plan that includes vision, mission, objectives and long-term operational plans. Among the hospitals that do not use business performance management practices, 55.6 % claim to have strategic planning composed at least of mission, vision and long-term objectives. However, they stated that the entity has no plans to adopt any method. Conclusions This diagnosis intends to draw the attention of managers and other actors in the field of public health on the possibilities offered by performance evaluation systems to promote administrative improvements in a complex internal scenario with a need for rationalization of hospital costs in order to direct these institutions towards achieving their social mission.(AU)

RESUMEN Objetivo Investigar si la evaluación del desempeño empresarial es una práctica utilizada por los hospitales federales brasileños, y en caso que haya instituciones que utilicen esta herramienta, verificar cuales prácticas son utilizadas e investigar las posibles características que permiten adoptar las mismas. Método El estudio utilizó la investigación descriptiva, siendo ex post facto en cuanto a los efectos en las variables estudiadas, y con relación a los procedimientos técnicos, se utilizaron datos secundarios y recursos de encuesta. Resultados Los resultados muestran que cuatro hospitales utilizan prácticas sobre la evaluación del desempeño empresarial; tres de ellos declararon que utilizan dos tipos de prácticas diferentes y que el 75 % de los hospitales universitarios que tienen al menos una práctica de evaluación del desempeño empresarial, también tienen un plan estratégico con visión, misión e objetivos y planes operativos a largo plazo. Entre los hospitales que no tienen prácticas sobre la evaluación del desempeño empresarial, el 55,6 % afirman tener una planificación estratégica compuesta al menos de misión, visión y objetivos a largo plazo. Sin embargo, declararon que la entidad no tiene planes de adoptar ningún método elencado. Conclusiones Este diagnóstico pretende llamar la atención a la gerencia y a los funcionarios del campo de la salud pública, sobre las posibilidades que ofrecen los sistemas de evaluación del desempeño de las entidades, para promover mejoras administrativas en un escenario interno complejo, así como la continua necesidad de racionalización de los costos hospitalarios, de forma tal que conduzca estas instituciones a alcanzar su misión social.(AU)

Knowledge about emergency contraception among women referred for treatment at a university hospital in Brazil

BACKGROUND: Emergency contraception (EC) has many important indications. The aim of the study was to investigate the prevalence of use and knowledge about the correct use of EC among women referred for treatment at a university hospital in Brazil. AIM: The aim of the study was to investigate the prevalence of use and knowledge about the correct use of EC among women referred for treatment at a university hospital in Brazil. METHODS: Study Design: Cross-sectional study. Settings: The study was conducted with patients admitted to the Hospital de Clínicas de Porto Alegre (HCPA) from 2009 to 2010. Patients: Sexually active women aged 18 to 50 years. Interventions: Patients answered a questionnaire on the use of and knowledge about EC. Main Outcome Measures: Primary outcome: prevalence of knowledge about correct EC use. Secondary outcome: prevalence of EC use. RESULTS: 134 patients participated in this study. 61.2% of women reported regular use of birth control pills, 18.7% of condoms, 9.0% of other methods, 3.0% of intrauterine device, and 8.1% used no contraceptive method. As for EC, 86.5% of interviewees reported having knowledge about the method, and 43.1% of these reported knowing how to use EC. However, only 12.0% of interviewees correctly reported how EC should be used. The prevalence of EC use in our sample was 19.4%. CONCLUSIONS: Although most interviewees reported having some knowledge about EC, only a small number were able to accurately describe its proper use.

Taxas de infecção relacionadas a partos cesáreos e normais no Hospital de Clínicas de Porto Alegre / Rates of infection related to cesarean and vaginal delivery at HCPA

Introdução: Indicadores de gestão hospitalar são utilizados para mensurar quantitativamente a qualidade da gestão e proporcionam informações fundamentais para o seu controle. Esse estudo compara a taxa de infecção pós-parto relacionada aos partos cesáreo e vaginal. Embora o risco de infecção puerperal esteja presente em ambos os procedimentos, o risco é maior após o parto por cesariana, devido à natureza invasiva do procedimento. Objetivo: Comparar a taxa de infecção puerperal relacionada ao parto cesáreo com a taxa relacionada ao parto normal. Métodos: Estudo de coorte retrospectivo, de caráter observacional, cujos dados foram coletados no Sistema de Indicadores de Gestão do Hospital de Clínicas de Porto Alegre, abrangendo o período de janeiro de 2004 a dezembro de 2010. Resultados: A taxa de cesariana no Hospital de Clínicas de Porto Alegre foi de 32,55% durante o período investigado. Entre os nascimentos, durante o mesmo período, a taxa de infecção após partos por cesariana foi de 2,8%, e de 0,8% após partos vaginais (p < 0,001). Conclusão: A taxa de infecção associada à cesariana é maior do que a relacionada aos partos normais. A taxa de infecção de cesarianas vem diminuindo desde 2004, após esse hospital ter adotado como rotina a administração de antibiótico profilaxia durante a indução anestésica.

Introduction: Hospital management indicators are used to measure service quality and provide important information for quality control. This study compares the postpartum infection rate following cesarean and vaginal delivery. Although risk of infection is present in both procedures, the risk is higher after cesarean delivery because of the invasive nature of the procedure. Objective: To compare the rate of puerperal infection after cesarean and vaginal delivery. Methods: The data for this retrospective cohort study were collected from the Management Indicator System (IG) of the Hospital de Clínicas de Porto Alegre (HCPA), covering the period from January 2004 to December 2010. Results: The rate of cesarean delivery at HCPA was 32.55% during the period investigated. Among births at HCPA during the same period, the infection rate after cesarean delivery and vaginal delivery was 2.8% and 0.8%, respectively (p<0.001). Conclusion: The rate of infection related to cesarean deliveries is higher than that related to vaginal deliveries. The infection rate of cesarean delivery has been declining since 2004 after the hospital adopted the routine administration of antibiotic prophylaxis during induction.

Acute toxicity test of agricultural pesticides on silver catfish (Rhamdia quelen) fingerlings / Teste de toxicidade aguda de pesticidas agrícolas em alevinos de jundiás (Rhamdia quelen)

Toxicity risks of agricultural pesticides to fishes are pivotal. Currently, many questions remain unsolved regarding to the toxicity of commonly used pesticides to silver catfish (Rhamdia quelen), a South American catfish. The present studies have been designed to investigate the acute toxicity and the lethal concentration (LC50) of four herbicides, two fungicides and two insecticides to silver catfish fingerlings. All experiments were carried out in triplicates, in a static bioassay system, using commercially available pesticides. The data was analyzed through the Trimmed Spearman-Karber method available from the Environmental Protection Agency. The 96hLC50 and 95 percent lower and upper confidence limits, respectively, for the following pesticides were determined: glyphosate (7.3mg L-1; 6.5-8.3), atrazine (10.2mg L-1; 9.1-11.5), atrazine+simazine (10.5mg L-1; 8.9-12.4), mesotrione (532.0mg L-1; 476.5-594), tebuconazole (5.3mg L-1; 4.9-5.7), methylparathion (4.8mg L-1; 4.3-5.3), strobulurin and triazol (9.9mg L-1; 8.7-11.2). Diflubenzuron was also tested and caused no fish mortality up to 1g L-1. The toxic concentration of these pesticides to silver catfish fingerlings fell above the concentration used for application in the field and, except following accidental application or misplacing of empty recipients, it should not cause fish mortality. Nonetheless, the data obtained will be useful to study the long-term effect of these products on the hematological, biochemical, hormonal and immunological parameters of silver catfish and related fish species in South Brazil.

A toxicidade dos defensivos agrícolas para peixes é um importante fator de risco a ser avaliado. Até o presente, muitos aspectos da toxicidade dos principais defensivos agrícolas para jundiá (Rhamdia quelen) ainda não foram investigados. No presente estudo, a toxicidade aguda e a concentração letal (CL50) de quatro herbicidas, dois fungicidas e dois inseticidas foram determinadas para alevinos de jundiás. Todos os experimentos foram conduzidos em triplicatas, utilizando-se um sistema de bioensaio estático e pesticidas comercializados localmente. Os dados foram analisados usando-se o método de Trimmed Spearman-Karber disponível na Agência de Proteção Ambiental (EUA). A CL50-96hr e os limites inferiores e superiores, com 95 por cento de confiança, respectivamente, para os seguintes produtos, foram: glifosato (7,3mg/L; 6,5 - 8,3), atrazina (10,2mg L-1; 9,1-11,5), atrazina+simazina (10,5mg L-1; 8,9-12,4), mesotrione (532,0mg L-1; 476,5-594), tebuconazol (5,3mg L-1; 4,9-5,7), metilparation (4,8mg L-1; 4,3-5,3), estrobilurina e triazol (9,9mg L-1; 8,7-11,2). O diflubenzuron também foi testado, mas não causou mortalidade nos alevinos até a concentração de 1g/L. A toxicidade dos produtos testados ficou acima das concentrações utilizadas para aplicação nas lavouras e, exceto nos casos de aplicação acidental ou despejo inadequado dos recipientes, esses produtos não poderiam causar morte de jundiás. No entanto, os dados obtidos nesses experimentos serão úteis para estudar o efeito, a longo prazo (intoxicação crônica), desses produtos, nos parâmetros hematológicos, bioquímicos, hormonais e imunológicos do jundiá e de espécies similares presentes no Sul do Brasil.

Neoplasias musculares do esôfago e estômago / Muscular neoplasms of the esophagus and stomach

Os autores apresentam a experiência adquirida em sete tumores musculares localizados no esôfago e no estômago. A disfagia, a hemorragia e a obstruçäo gástrica foram os sintomas mais freqüentes, embora dois pacientes fossem assintomáticos. Ressultam a importância do diagnóstico histológico pré-operatório através da biópsia endoscópica a fim de determinar a conduta operatória mais adequada. A enucleaçäo ou ressecçäo foi empregada como tratamento definitivo nos casos operados. As complicaçöes, no pós-operatório, foram broncopneumonia e íleo prolongado em dois casos. Näo houve óbitos nesta série