Waiting time for kidney transplantation based on calculated panel reactive antibodies: experience of a southern Brazilian center / Tempo de espera para transplante renal com base em painel de reatividade de anticorpos calculado: experiência de um centro do sul do Brasil

ABSTRACT Introduction: The aim of this study was to analyze the waiting list for kidney transplantation in our hospital according to candidate's panel reactive antibodies (cPRA) and its outcomes. Methods: One thousand six hundred forty patients who were on the waiting list between 2015 and 2019 were included. For the analysis, hazard ratios (HR) for transplant were estimated by Fine and Gray's regression model according to panel reactivity and HR for graft loss and death after transplantation. Results: The mean age was 45.39 ± 18.22 years. Male gender was predominant (61.2%), but the proportion decreased linearly with the increase in cPRA (p < 0.001). The distribution of patients according to panels were: 0% (n = 390), 1% - 49% (n = 517), 50% - 84% (n = 269), and ≥ 85% (n = 226). Transplantation was achieved in 85.5% of the sample within a median time of 8 months (CI 95%: 6.9 - 9.1). The estimated HRs for transplantation during the follow-up were 2.84 (95% CI: 2.51 - 3.34), 2.41(95%CI: 2.07 - 2.80), and 2.45(95%CI: 2.08 - 2.90) in the cPRA range of 0%, 1%-49%, and 50%-84%, respectively, compared to cPRA ≥ 85 (p < 0.001). After transplantation, the HR for graft loss was similar in the different cPRA groups, but the HR for death (0.46 95% CI 0.24-0.89 p = 0.022) was lower in the 0% cPRA group when adjusted for age, gender, and presence of donor specific antibodies (DSA). Conclusion: Patients with cPRA below 85% are more than twice as likely to receive a kidney transplantation with a shorter waiting time. The risk of graft loss after transplantation was similar in the different cPRA groups, and the adjusted risk of death was lower in nonsensitized recipients.

RESUMO Introdução: O objetivo foi analisar a lista de espera para transplante renal em nosso hospital segundo o painel de reatividade de anticorpos (PRAc) do candidato e seus desfechos. Métodos: Incluímos 1.640 pacientes em lista de espera entre 2015 e 2019. Para a análise, estimou-se a razão de risco (HR) para transplante pelo modelo de regressão de Fine e Gray conforme o painel de reatividade e HR para perda do enxerto e óbito após o transplante. Resultados: A idade média foi 45,39 ± 18,22 anos. Sexo masculino foi predominante (61,2%), mas a proporção diminuiu linearmente com o aumento do PRAc (p < 0,001). A distribuição de pacientes conforme os painéis foi: 0% (n = 390), 1% - 49% (n = 517), 50% - 84% (n = 269), e ≥85% (n = 226). O transplante foi realizado em 85,5% da amostra em tempo mediano de 8 meses (IC 95%: 6,9 - 9,1). As HRs estimadas para transplante durante o acompanhamento foram 2,84 (IC 95%: 2,51 - 3,34), 2,41 (IC 95%: 2,07 - 2,80) e 2,45 (IC 95%: 2,08 - 2,90) no intervalo de PRAc de 0%, 1%-49% e 50%-84%, respectivamente, comparadas com PRAc ≥ 85 (p < 0,001). Após o transplante, a HR para perda do enxerto foi semelhante nos diferentes grupos de PRAc, mas HR para óbito (0,46 IC 95% 0,24-0,89 p = 0,022) foi menor no grupo PRAc 0% quando ajustada para idade, sexo e presença de anticorpos doador específico (DSA). Conclusão: Pacientes com PRAc abaixo de 85% têm mais que o dobro de probabilidade de receber transplante renal com tempo de espera menor. Risco de perda do enxerto após o transplante foi semelhante nos diferentes grupos PRAc, e risco ajustado de óbito foi menor em receptores não sensibilizados.

Effects of prolonged waiting time on visual outcomes of patients with pediatric cataract in a Tertiary Public Hospital

Background@#Pediatric cataract is one of the most common preventable cause of childhood blindness worldwide. Early and timely intervention of pediatric cataract is important to maximize the visual outcomes and start prompt visual rehabilitation.@*Objectives@#This study aimed to determine the average time from the day of initial consult at the outpatient clinic to the day of the cataract surgery and compare the effects of delayed surgery on visual outcomes of patients.@*Methods@#This is a retrospective chart review of medical records from January 2015 to June 2022. The dates of the different steps in the process up to the day of intervention were noted and the average interval duration and the total waiting time were determined. Patients operated on within 2 weeks from initial consult was defined as no delay while those operated >2 weeks had delayed surgery. Pre-operative and post-operative best corrected log MAR visual acuity were compared within each group to determine if delay in surgical intervention has a significant effect on the visual outcomes of patients.@*Results@#Median age at initial consult was 4.9 years while median age at surgery was 5.2 years. Ninety-nine (99) patients had developmental cataract and 123 patients had bilateral cataract. Leukocoria was the most common chief complaint (63.45%). Pre-operatively, 94 patients had strabismus, 49 had eye preference, 48 had nystagmus, and 43 had amblyopia in the diagnosis. There was significantly faster admission to cataract surgery during the pandemic compared to pre-pandemic period but there was no difference in the total waiting time. Patients with congenital cataract had the least total waiting time followed by developmental, and rubella cataract. There is no significant difference in visual outcomes between patients operated without delay and with delay.@*Conclusion@#There is delayed age at diagnosis and surgery of pediatric cataract patients in the Philippine General Hospital. Early surgery did not reflect better visual outcomes compared to delayed surgery probably due to delay in consultation of patients.

Improving the Waiting Time in Outpatient Clinics Using Lean Approach in Hospital: A Systematic Review

@#Introduction: The use of the lean approach in healthcare has rapidly gained popularity globally, although this approach was more routinely used in the manufacturing sector as opposed to health. Besides, recent studies confirm the suitability of the lean approach applications for improving the quality of medical care. This study aimed to determine the Lean approach’s capacity to improve the waiting time in outpatient clinics in hospitals. Methods: The systematic review approach was employed to help in the research procedures. Search databases used included Ovid, Google scholar, PubMed, MEDLINE, and archive. Besides, search terminologies such as the Lean approach, Hospital-implementation, waiting time, and patient flow were used to help identify sources that best suited the investigation process. Results: The review revealed that the lean approach is suitable for the reduction of waiting times as well as for improving efficiency in the clinic. The outcomes provide a basis for reducing the average waiting time within the hospital. Conclusion: This study recommended that healthcare facilities and departments should take a keen interest in implementing the Lean approaches, as they are crucial for reducing waiting time.

Evidências de validade de umsoftware para gestão da fila cirúrgica eletiva / Evidence of validity of software for managing the elective surgical queue

Objetivo: Desenvolver um software para gestão da fila cirúrgica eletiva. Métodos: Estudo metodológico, conduzido para desenvolver e validar um protótipo computacional na forma de software. Para validar o conteúdo, participaram 55 juízes selecionados intencionalmente. Empregou-se o Índice de Validação de Conteúdo para medir o grau e a porcentagem de concordância entre os juízes. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Piauí, com Nº de Parecer 5.306.171. Resultados: As evidências de validade do conteúdo foram consideradas satisfatórias, indicando clareza, adequação aos objetivos propostos, coerência, atualização, organização lógica, precisão e objetividade, além de apresentar potencialidades para que os pacientes possam acompanhar o seu posicionamento na fila. Conclusão: O desenvolvimento do software reúne evidências válidas e favoráveis para a organização e gestão da lista de espera cirúrgica, permitindo a priorização de casos com base na gravidade clínica e no senso de urgência.(AU)

Objective: To develop a software for elective surgery queue management. Methods: Methodological study, conducted to develop and validate a computational prototype in the form of software. To validate the content, 55 intentionally selected judges participated. The Content Validation Index was used to measure the degree and percentage of agreement between the judges. The study was approved by the Research Ethics Committee of the Federal University of Piauí, with Opinion No. 5.306.171. Results: The evidence of content validity was considered satisfactory, indicating clarity, adequacy to the proposed objectives, coherence, updating, logical organization, precision and objectivity, in addition to presenting potentialities for patients to monitor their position in the queue. Conclusion: The development of the software brings together valid and favorable evidence for the organization and management of the surgical waiting list, allowing the prioritization of cases based on clinical severity and sense of urgency.(AU)

Objetivo: Desarrollar un software para la gestión de colas de cirugía electiva. Métodos: Estudio metodológico, realizado para desarrollar y validar un prototipo computacional en forma de software. Para validar el contenido, participaron 55 jueces seleccionados intencionadamente. Se utilizó el Índice de Validación de Contenido para medir el grado y el porcentaje de acuerdo entre los jueces. El estudio fue aprobado por el Comité de Ética en Investigación de la Universidad Federal de Piauí, con el Dictamen nº 5.306.171. Resultados: Las evidencias de validez de contenido fueron consideradas satisfactorias, indicando claridad, adecuación a los objetivos propuestos, coherencia, actualización, organización lógica, precisión y objetividad, además de presentar potencial para que los pacientes monitoreen su posición en la fila. Conclusión: El desarrollo del software reúne evidencias válidas y favorables para la organización y gestión de la lista de espera quirúrgica, permitiendo la priorización de los casos en función de la gravedad clínica y del sentido de urgencia.(AU)

Teorías subjetivas sobre el tiempo de espera y experiencias de la parentalidad adoptiva / Subjective theories about waiting time and experiences from adoptive parenting

Resumen El proceso de adopción comprende cambios importantes en las familias adoptivas, pues implica una reestructuración y adaptación a una nueva organización del sistema familiar. Durante este proceso los padres elaboran expectativas y creencias respecto a cómo comportarse frente a los cambios y adaptarse a sus hijos, desde donde dirigen sus prácticas de crianza. La percepción del tiempo que tenga cada persona posee un papel en cómo se desarrolla la identidad tanto individual como familiar, pues las experiencias pasadas, vivencias actuales y expectativas del futuro influyen en sus acciones. Por lo tanto, es posible decir que los padres adoptivos elaboran teorías subjetivas sobre este proceso y especialmente en relación con el tiempo de espera de la adopción, explicaciones que podrían incidir en la forma en que enfrentan este nuevo desafío y se preparan para la parentalidad. El presente estudio tuvo por objetivo comprender las teorías subjetivas sobre el tiempo de espera y las experiencias de la parentalidad adoptiva. Participaron diez madres y padres adoptivos mediante entrevistas episódicas individuales. Se analizaron los datos obtenidos utilizando técnicas de tres procedimientos de análisis: de contenido basado en la Teoría Fundamentada, específico para las teorías subjetivas y de la perspectiva temporal. De los hallazgos se destacan teorías subjetivas de contenido emocional ansioso durante el proceso de adopción. Además, contar con una red de apoyo, compartir experiencias con otros padres y el uso de estrategias personales son las principales estrategias de adaptación de los padres adoptivos que les permiten sobrellevar los sentimientos negativos durante el proceso.

Abstract The adoption process includes important changes in adoptive families, since it implies a restructuring and adaptation to a new organization of the family system. The path to parenthood entails changes at levels of mental, physical and social health, which in the case of adoptive parents, the challenges are greater or are altered in some way due to the unique characteristics of their experiences and the obstacles they face. To these challenges are added the usual stressors that parents face, such as changes in roles, increased stress, lack of sleep, alterations in the relationship and intimacy of the couple and difficulties that arise in raising their children. On the other hand, time is configured as a concrete dimension through which life develop. The relationship between objective time and subjective or psychological time will shape the perception of time that each person has, which has a role in how both individual and family identity develops. This is because people´s actions are influenced by past experiences, current experiences and future expectations. One of the areas of the adoption process that has not yet been deepened is the waiting time, the period of time between obtaining the suitability and assignment of the minor to the adoptive family, which can be considered important for the future family depending on how adoptive parents face it, this because the way in which the adoption process is experienced impacts both the path to parenthood and post-adoption adaptation. In fact, it confirms that waiting time influences the psychological well-being of adoptive parents. Therefore, it is possible to say that adoptive parents elaborate subjective theories about this process and especially in relation to the waiting time for adoption, explanations that could influence the way in which they face this new challenge and prepare for parenthood. The present study aimed to understand subjective theories about the waiting time and experiences of adoptive parenting. Ten adoptive mothers and fathers participated in this study through individual episodic interviews. The data obtained were analyzed using techniques of three analysis procedures: content based on Grounded Theory, specific for subjective theories and time perspective.

O processo ensino-aprendizagem na construção e aplicação de ação educativa em sala de espera: relato de experiência / El proceso de enseñanza-aprendizaje en la construcción y aplicación de la acción educativa en la sala de espera: informe de experiencia / The teaching-learning process in the construction and application of educational action in the waiting room: experience report

Objetivo: Relatar o processo de ensino aprendizagem na construção e aplicação de ações educativas na sala de espera de uma unidade básica de saúde. Método: Relato de experiência executado pelo método Blended Learning, com abordagem pelo construtivismo e analisada por meio da Teoria da Atividade. Foi executada entre julho e setembro de 2021 pela Universidade Federal do Pará. Participaram discentes do terceiro semestre de graduação em enfermagem, docente e discente de pós-graduação de Enfermagem. Resultados: Apresenta-se estruturado em 3 etapas: Revisão da Literatura, Desenvolvimento e construção das tecnologias educacionais e Aplicação no serviço de saúde. Identificou-se como potenciais estratégias as atividades em grupo, com metodologias ativas, lúdicas, mediadas por interações e para reconstrução do conhecimento. O planejamento seguiu os fatores-chave: conteúdo, processo e forma. Considerações Finais: A experiência apontou que ações em sala de espera podem ser mediadas por metodologias ativas a partir de interações tecnológicas e dos pontos-chave do ensino-aprendizagem.

Objective: To report the teaching-learning process in the construction and application of educational action in the waiting room of abasic health unit. Method: Experience report performed by the Blended Learning method, with approach by constructivism and analyzed through activity theory. It was executed between July and September 2021 by the Federal University of Pará. Participants were students of the third semester, professor and graduate student of Nursing. Results: It is structured in 3 Phases: Literature Review, Development and construction of educational technologies and Application in the health service. Group activities were identified as potential strategies, with active methodologies, playful, mediated by interactions and for knowledge reconstruction. Planning followed the key factors: content, process and form. Final Considerations: The experience pointed out that actions in the waiting room can be mediated by active methodologies based on technological interactions and the key points of teaching-learning.

Objetivo: Relatar el proceso de enseñanza-aprendizaje en la construcción y aplicación de la acción educativa en la sala de espera de una unidad básica de salud. Método: Informe de experiencia realizado por el método Blended Learning, con enfoque por constructivismo y analizado a través de la teoría de la actividad. Fue ejecutado entre julio y septiembre de 2021 por la Universidad Federal de Pará. Participaron estudiantes del tercer semestre, profesor y estudiante graduado de Enfermería. Resultados: Se estructura en 3 Fases: Revisión de la Literatura, Desarrollo y construcción de tecnologías educativas y Aplicación en el servicio de salud. Las actividades grupales fueron identificadas como estrategias potenciales, con metodologías activas, lúdicas, mediadas por interacciones y para la reconstrucción del conocimiento. La planificación siguió los factores clave: contenido, proceso y forma. Consideraciones finales: La experiencia señaló que las acciones en la sala de espera pueden ser mediadas por metodologías activas basadas en interacciones tecnológicas y los puntos clave de enseñanza-aprendizaje.

Medical and non-medical factors that influence the kidney transplantation technical registry: a cross-sectional study / Fatores clínicos e não clínicos que influenciam o cadastro técnico para transplante renal: estudo transversa

INTRODUCTION: Chronic kidney disease is a worldwide public health problem, because of its association with an elevated risk of mortality, low quality of life, and prohibitive cost to the health system. OBJECTIVE: To identify the factors that might influence the kidney transplantation technical registry. METHODS: Cross-sectional study of descriptive analysis conducted in six dialysis health care centers in the south of Rio Grande do Sul, Brazil. Patients over 18 years of age were included in this study in 2016 and 2017. The demographic and clinical variables were subjected to Pearson's chi-square test using Stata Software for statistical analysis. Research approved by the Ethics Committee 1386385. RESULTS: Of 314 participants, 228 (72.6%) were not on the kidney transplantation technical registry. The medical and non-medical factors with statistical significance were age (p<0.01), income (p<0.01), having children (p=0.01), time since diagnosis (p=0.01), and time on hemodialysis (p=0.01). CONCLUSION: There is a substantial proportion of 72.6% of hemodialysis patients not registered on the kidney transplantation technical registry. The identification of factors that influence the kidney transplantation technical registry contributes both theoretically and to healthcare management, by the health team and government who can direct strategies towards the most appropriate health care. Health professionals should be aware of the impact of these factors and how the factors might pose a risk of complications that make it impossible to register on the kidney transplantation waiting list.

INTRODUÇÃO: A doença renal crônica é um problema de saúde pública mundial, pois está associada ao alto risco de mortalidade, baixa qualidade de vida e elevado custo ao sistema de saúde. OBJETIVO: Identificar os possíveis fatores que podem influenciar o acesso ao cadastro técnico para transplante renal. MÉTODO: Estudo transversal de análise descritiva realizado em seis serviços de diálise da Metade Sul do Rio Grande do Sul, Brasil. Participaram desse estudo pacientes maiores de 18 anos nos anos de 2016 e 2017. As variáveis demográficas e clínicas foram submetidas ao teste qui-quadrado de Pearson utilizando o Software Stata para a análise estatística. Pesquisa aprovada pelo Comitê de Ética 1.386385. RESULTADOS: dos 314 pacientes em hemodiálise 228 (72,6%) não estavam no cadastro técnico para transplante renal. Os fatores clínicos e não clínicos que apresentaram significância estatística foram: idade (p<0,01), renda (p<0,01) possuir filhos (p=0,01), tempo de diagnóstico (p=0,01) e tempo em hemodiálise (p=0,01). CONCLUSÃO: Há uma proporção substancial de 72,6% pacientes em hemodiálise que não estão no cadastro técnico para transplante renal. A identificação dos fatores que influenciam no cadastro contribui tanto gerencial quanto teoricamente pois, possibilita que a equipe de saúde e os gestores possam direcionar estratégias para o cuidado em saúde mais adequado. Os profissionais de saúde devem estar cientes do impacto que esses fatores exercem e que podem oferecer risco de complicações que inviabilizem o cadastro técnico para transplante renal.

Impacts of the Delayed Surgical Correction of Adolescent Idiopathic Scoliosis and its Repercussions for the Brazilian Unified Health System: Systematic Review Protocol / Impactos da espera para correção cirúrgica da escoliose idiopática do adolescente e suas repercussões para o Sistema Único de Saúde: Protocolo de revisão sistemática

Abstract Surgical correction is an effective treatment for adolescent idiopathic scoliosis (AIS) with deformities over 45°. In the Brazilian Unified Health System (SUS, Sistema Único de Saúde), if the surgical procedure is indicated, the patients are placed on a waiting list and wait until the treatment can be performed. An extended waiting period can be harmful due to worsening symptoms and increased treatment costs. Additionally, it has negative effects on the mental health and quality of life of these patients. This paper is a systematic review protocol to answer the following question: "What is the impact of the delayed surgical correction of AIS considering costs and quality of life?" Collecting health status information is the first step to improve high complex public health actions. Future publications from this protocol may serve as a subsidy to point out potential priority criteria to enhance the global health of AIS patients and the management of Brazilian public health financial resources.

Resumo A correção cirúrgica é uma opção efetiva de tratamento para casos de Escoliose Idiopática do Adolescente (EIA) com curvas acima de 45°. No âmbito do Sistema Único de Saúde (SUS), os pacientes avaliados nos centros de referência e com indicação cirúrgica são cadastrados em fila de espera até que o tratamento definitivo possa ser realizado. Um período de espera extenso pode ser prejudicial, do ponto de vista de piora dos sintomas e de aumento do custo de tratamento, além de gerar efeitos negativos na saúde mental e na qualidade de vida do paciente. O presente artigo trata-se do protocolo de uma revisão sistemática que buscará responder o questionamento: "Qual o impacto do tempo de espera para correção cirúrgica da EIA do ponto de vista de custo e qualidade de vida?." O aperfeiçoamento das ações de saúde pública, na esfera da alta complexidade, inicia-se com o levantamento de informações sobre a situação de saúde de determinada condição. Diante disso, as futuras publicações provenientes deste protocolo poderão servir como subsídio para apontar possíveis critérios de prioridade, com o intuito de promover melhoria tanto no âmbito da saúde global de portadores de EIA, quanto na gestão financeira da saúde pública brasileira.

Assessing Countries’ Deceased Organ Donation and Transplantation Performance

@#Introduction: Donors per million population and transplantations per million population are standardized, widely used indicators to assess and compare countries’ performance in organ donation and transplantation. This study aims to investigate these two particular metrics of organ donation and transplantation performance, and to introduce a new index, namely, ‘transplantations per patients on the waiting list’. Methods: Secondary analyses of data on 23 countries in 2016 were used to construct the transplantations per patients on the waiting list indicator for kidney, liver, pancreas, heart, and lung transplantation, as well as for the transplantation of any of the five aforementioned organs. Results: According to the transplantations per patients on the waiting list, the best-performing countries in terms of organ donation and transplantation are Belarus for kidney transplantation, Finland for liver and pancreas transplantation, Australia for heart transplantation, and France for lung transplantation. Considering all five organs together, Sweden, Australia, Finland, Austria, and Poland were the top five best-performing countries, followed by Spain in the sixth position. Conclusion: The deceased transplantations per patients on the waiting list can be an alternative indicator to assess performance, along with the widely-used donors and transplantations per million population, but still has its limitations in certain scenarios.

Using healthcare failure mode and effect analysis to reduce the emergency waiting risk / 中国实用护理杂志

Objective:To explore the application of effect of healthcare failure mode and effect analysis (HFMEA) in emergency waiting risk management.Methods:From May 2020 to April 2021, totally 87 902 emergency waiting patients from the First Affiliated Hospital of Anhui Medical University were assigned to control group by cluster sampling method. From May 2021 to April 2022, 80 594 emergency waiting patients were assigned to observed group. The patients in the control group received routine emergency waiting of itinerant management mode. In contrast, the patients in the observed group received emergency waiting risk management mode based on HFMEA. The process risk priority number (RPN) and waiting risk management index between two groups were compared.Results:The mean RPN of the observed group was (98.48 ± 8.27) points, significantly lower than that of the control group (251.27 ± 16.95) points. The nurses′ pre-identification rates of changes in the condition and adverse reaction in the observed group were 10.77%(8680/80 594) and 13.37%(10 775/80 594), which were higher than those in the control group, 5.77%(5072/87 902) and 8.12%(7134/87 902), the differences were statistically significant ( χ2 values were 1402.32 and 1221.66, all P<0.05). Conclusions:The application of HFMEA to optimize the emergency waiting management process can effectively reduce the risk of emergency waiting and improve the quality of emergency waiting management.

Música como promotora da saúde na sala de espera de cirurgia: percepções de acompanhantes / Music as a health promoter in the surgery waiting room: companions' perceptions / La música como promotora de salud en la sala de espera de cirugía: percepciones de los acompañantes

Objetivo: compreender as percepções dos acompanhantes que aguardam notícias de seus entes queridos que estão em cirurgia, sobre a utilização da música como estratégia para promover saúde no hospital. Método: estudo descritivo, exploratório, qualitativo, fundamentado nos pressupostos teóricos da Promoção da Saúde, com a participação de 15 acompanhantes que aguardavam notícias de seus entes queridos em uma sala de espera no ambiente hospital. Realizaram-se entrevistas semiestruturadas e os dados foram organizados e analisados conforme análise de conteúdo. Resultados: os participantes destacaram algumas possibilidades para promover saúde na sala de espera de cirurgia do hospital, como a música, a qual proporciona distração da realidade preocupante, felicidade, vida, alegria, esperança, sensações boas, ânimo e tranquilidade. Considerações finais: a música destaca-se como tecnologia para promover saúde, despertando sentimentos positivos durante as intervenções musicais no hospital. Portanto, faz-se necessário ampliar a discussão e utilização da música como estratégia para promover saúde no âmbito hospitalar

Objective: to understand the perceptions of companions awaiting news from their loved ones who are undergoing surgery, about the use of music as a strategy to promote health in the hospital. Method: a descriptive, exploratory, qualitative study, based on the theoretical assumptions of Health Promotion, with the participation of 15 companions who were waiting for news from their loved ones in a waiting room in the hospital environment. Semi-structured interviews were carried out and the data were organized and analyzed according to content analysis. Results: the participants highlighted some possibilities to promote health in the hospital surgery waiting room, such as music, which provides distraction from the worrying reality, happiness, life, joy, hope, good feelings, cheer and tranquility. Final considerations: music stands out as a technology to promote health, arousing positive feelings during musical interventions in the hospital. Therefore, it is necessary to expand the discussion and use of music as a strategy to promote health in the hospital environment

Objetivo: comprender las percepciones de acompañantes en espera de noticias de sus seres queridos que están siendo operados, sobre el uso de la música como estrategia de promoción de la salud en el hospital. Método: estudio descriptivo, exploratorio, cualitativo, basado en los presupuestos teóricos de la Promoción de la Salud, con la participación de 15 acompañantes que esperaban noticias de sus seres queridos en una sala de espera del ambiente hospitalario. Se realizaron entrevistas semiestructuradas y los datos fueron organizados y analizados según el análisis de contenido. Resultados: los participantes destacaron algunas posibilidades para promover la salud en la sala de espera de cirugía hospitalaria, como la música, que proporciona distracción de la realidad preocupante, alegría, vida, alegría, esperanza, buenos sentimientos, alegría y tranquilidad. Consideraciones finales: la música se destaca como tecnología para promover la salud, despertando sentimientos positivos durante las intervenciones musicales en el hospital. Por lo tanto, es necesario ampliar la discusión y el uso de la música como estrategia de promoción de la salud en el ámbito hospitalario

Reasons referred by individuals who were not on kidney transplantation waiting lists / Razones referidas por individuos que no estaban en lista de espera de trasplante renal / Motivos referidos pelos indivíduos que não estavam em lista de espera para o transplante renal

ABSTRACT Objective: To describe the reasons reported by individuals in hemodialysis that were not registered on kidney transplantation waiting lists. Methods: Cross-sectional study conducted in six renal replacement therapy services in Rio Grande do Sul, Brazil with 214 individuals undergoing hemodialysis who reported the reasons for not being registered on kidney transplantation waiting lists. The data collection was carried out through a questionnaire from March 2016 to March 2017. The Stata software was used to the statistical analysis and independence test. Results: The main reasons reported by the 214 individuals who were not registered on kidney transplantation waiting lists were due to the lack of information of the individuals, not wanting to be on list, due to morbidities and age. Conclusions: The lack of information was associated with the variables low education, male, ≤ 5 years of time since diagnosis and ≤ 5 years in renal replacement therapy. The reason for not wanting to be on the list was associated with the variables illiteracy and age.

RESUMEN Objetivo: Describir las razones informadas por personas en hemodiálisis que no estaban registradas en lista de espera para trasplante renal. Métodos: Estudio transversal realizado en Rio Grande do Sul, Brasil en seis servicios de terapia sustitutiva renal con 214 individuos en hemodiálisis que informaron los motivos de no estar registrados en listade espera para trasplante renal. La recolección de datos se realizó mediante un cuestionario entre marzo de 2016 y marzo de 2017. Para el análisis estadístico descriptivo y test de independencia se utilizó el software Stata. Resultados: Las principales razones reportadas por las 214 personas que no estaban inscritas en listade espera para trasplante renal fueron la falta de información de las personas, no querer estar en lista, impedimento por multimorbilidad y edad. Conclusiones: La falta de información se asoció con las variables baja escolaridad, género masculino, ≤ 5 años de tiempo desde el diagnóstico y ≤ 5 años en terapia de reemplazo renal. El motivo de no querer estar en la lista estuvo asociado a las variables no saber leer y edad.

RESUMO Objetivo: Descrever os motivos referidos pelos indivíduos em hemodiálise que não estavam cadastrados em lista de espera para o transplante renal. Métodos: Estudo transversal realizado no Rio Grande do Sul, Brasil em seis serviços de terapia de substituição renal com 214 indivíduos em hemodiálise que referiram os motivos de não estarem cadastrados em lista de espera para o transplante renal. A coleta de dados foi realizada por meio de questionário entre março de 2016 e março de 2017. Para a análise estatística descritiva e do teste de independência, utilizou-se o software Stata. Resultados: Os principais motivos referidos pelos 214 indivíduos que não estavam cadastrados em lista de espera para o transplante renal foram: a falta de informação dos indivíduos, não desejar estar em lista, o impedimento por multimorbidade e a idade. Conclusões: A falta de informação apresentou associação com as variáveis baixa escolaridade, sexo masculino, ≤ 5 anos de tempo de diagnóstico e ≤ 5 anos em terapia de substituição renal. O motivo não desejar estar em lista esteve associado com as variáveis não saber ler e idade.

Simulación y optimización de sistemas de vacunación con capacidad finita / Simulation and optimization of systems vaccination with finite capacity

Resumen Objetivo: Caracterizar y optimizar el flujo de pacientes dentro de un centro de vacunación, para los casos donde debe tomarse en cuenta que existe una capacidad finita en las colas frente a las estaciones. Materiales y Métodos: Se asume que los sistemas de vacunación se comportan como una red cerrada de colas con capacidad finita; para caracterizar el flujo de pacientes, se aplica simulación y un diseño experimental Box-Bhenken, donde las variables son las capacidades en las colas (buffer); posteriormente se obtienen los metamodelos del tiempo de ciclo y del número de pacientes vacunados, finalmente se calcula la asignación óptima de los lugares en las colas aplicando programación matemática. Resultados: Las colas de llenado de formatos, entrega de información y vacunación son las de mayor efecto sobre el tiempo de estadía; las colas de vacunación y el Triage son las de mayor efecto sobre la cantidad de pacientes vacunados.Si se maximiza la salida de pacientes, la mayor cantidad de lugares deben asignarse a la estación de vacunación y el resto de los espacios se distribuyen en las demás estaciones; por otra parte, si se minimiza el tiempo de estadía, entonces la mayor parte de los lugares se asignan a la estación Triage y a continuación a la estación de Vacunación, el resto de los espacios se asignarán dependiendo de la capacidad total del sistema. Conclusiones: Los responsables de administrar esta clase de sistemas deben definir el criterio bajo el cual deben cuantificar el desempeño del sistema de vacunación y a partir de este, gestionar y controlar el proceso. Cuando la demanda supera las expectativas y no es viable incrementar la capacidad, entonces la alternativa es optimizar el flujo controlando la cantidad de personas dentro del sistema.

Abstract Objective: Characterize and optimize the flow of patients within a vaccination center, for cases where it must be consider that there is a finite capacity in the queues in front of the stations. Materials and Methods: Vaccination systems are assumed to behave as a closed queue network with finite capacity; To characterize the flow of patients, simulation and a Box-Bhenken experimental design are applied, where the variables are the capacities in the queues (buffer); Subsequently, the metamodels of the cycle time and the number of vaccinated patients are obtained. Finally, the optimal allocation of places in the queues is calculated by applying mathematical programming. Results: The queues for filling out forms, delivery of information and vaccination are the ones with the greatest effect on the length of stay; the vaccination and triage queues have the greatest effect on the number of vaccinated patients. If the output of patients is maximized, the greatest number of places should be assigned to the vaccination station and the rest of the spaces are distributed in the other stations; On the other hand, if the length of stay is minimized, then most of the places are assigned to the Triage station and then to the Vaccination station, the rest of the spaces will be assigned depending on the total capacity of the system. Conclusions: Those responsible for managing this class of systems must define the criteria under which they must quantify the performance of the vaccination system and, based on this, manage and control the process. When demand exceeds expectations and increasing capacity is not feasible, then the alternative is to optimize flow by controlling the number of people within the system.

Lista de espera para transplante hepático: impacto clínico e econômico / Waiting list for liver transplantation: clinical and economic burden

ABSTRACT Background Burden of disease is an indicator that relates to health status. United States and European epidemiological data have shown that the burden of chronic liver disease has increased significantly in recent decades. There are no studies evaluating the impact of complications of chronic liver disease on the waiting list for deceased donor liver transplantation (LTx). Objective: To determine the clinical and economic burden of complications of liver disease in wait-listed patients from the perspective of a transplant center. Methods The study retrospectively analyzed medical records of 104 patients wait-listed for deceased donor LTx from October 2012 to May 2016 and whose treatment was fully provided at the study transplant center. Clinical data were obtained from electronic medical records, while economic data were collected from a hospital management software. To allocate all direct medical costs, two methods were used: full absorption costing and micro-costing. Results: The most common complication was refractory ascites (20.2%), followed by portosystemic encephalopathy (12.5%). The mean number of admissions per patient was 1.37±3.42. Variceal hemorrhage was the complication with longest median length of stay (18 days), followed by hepatorenal syndrome (13.5 days). Hepatorenal syndrome was the costliest complication (mean cost of $3,565), followed by portosystemic encephalopathy ($2,576) and variceal hemorrhage ($1,530). Conclusion: The burden of chronic liver disease includes a great cost for health systems. In addition, it is likely to be even greater as a result of the insidious course of the disease.

RESUMO Contexto O impacto da doença é um indicador relacionado ao estado de saúde. Dados epidemiológicos norte-americanos e europeus mostraram que, nas últimas décadas, o impacto da doença hepática crônica tem aumentado significativamente. Não há estudos que avaliem o impacto das descompensações da doença hepática crônica na lista de espera para transplante hepático (TxH) com doador falecido. Objetivo: Determinar o impacto clínico e econômico das descompensações da doença hepática nos pacientes em lista de espera sob a perspectiva do centro transplantador. Métodos Foram analisados, retrospectivamente, os prontuários de 104 pacientes incluídos em lista de espera para TxH com doador falecido entre outubro de 2012 e maio de 2016 e acompanhados integralmente no centro transplantador. Dados clínicos foram obtidos do prontuário eletrônico, enquanto dados econômicos foram coletados através de software de gestão hospitalar. A apropriação dos custos médicos diretos foi realizada sob duas metodologias: custeio por absorção pleno e microcusteio. Resultados: A descompensação com maior incidência foi a ascite refratária (20,2%) seguida de encefalopatia portossistêmica (12,5%). A média de internações por paciente foi de 1,37±3,42. A hemorragia digestiva alta varicosa foi a descompensação com maior tempo mediano de internação (18 dias), seguida da síndrome hepatorrenal (13,5 dias). A descompensação mais onerosa foi a síndrome hepatorrenal (custo médio de US$ 3.565), seguida encefalopatia portossistêmica (US$ 2.576) e a hemorragia digestiva alta varicosa (US$ 1.530). Conclusão O impacto da doença hepática crônica inclui um custo importante para os sistemas de saúde. Além disso, é provável que seja ainda maior em decorrência do curso insidioso da doença.

Espera, vulnerabilidades e subjugação no contexto das migrações / The waiting, vulnerabilities, and subjugation in the context of migration

Resumo: O artigo aborda, a partir do método de revisão sistemática da literatura, as condições de regularização dos imigrantes em que a espera para a obtenção de uma cidadania ativa é potenciadora de vulnerabilidade social, remetendo a população migrante para os mecanismos de poder da terra de ninguém. Foram analisados 548 artigos, documentos oficiais e relatórios de políticas públicas. Concluímos que a espera é a mãe da cidadania adiada, produtora da ausência de direitos no deserto da terra de ninguém.

Abstract: Based on the systematic literature review method, this article addresses the conditions of regularization of immigrants where the wait to obtain an active citizenship is potentiator of social vulnerability, referring the migrant population to the power mechanisms of no man's land. We analyzed 548 articles, official documents, and public policy reports. We conclude that waiting is the mother of deferred citizenship, producer of the absence of rights in the desert of no man's land.

Consideraciones actuales sobre el diagnóstico y tratamiento del cáncer tiroideo

Introducción: Desde los inicios de este siglo se ha producido un notable incremento mundial de la tasa de incidencia del cáncer de tiroides, el cual generalmente tiene un curso larvado y asintomático. Objetivo: Profundizar en el conocimiento de los aspectos novedosos del diagnóstico oportuno y tratamiento personalizado del cáncer tiroideo. Desarrollo: El cáncer tiroideo es la enfermedad maligna más frecuente del sistema endocrino. En las últimas décadas, su incidencia se ha incrementado aceleradamente, aunque la mortalidad se ha mantenido baja. El descubrimiento y desarrollo de nuevas técnicas de imágenes, inmunológicas y moleculares, han permitido estudiar en profundidad la neoplasia de la tiroides. Esto ha favorecido avanzar en los aspectos que más han modificado la nueva actitud respecto al diagnóstico oportuno y su tratamiento. Conclusiones: En años recientes, los avances de las investigaciones básicas, clínicas y traslacionales (aplicación real de los conocimientos básicos en la práctica clínica), han transformado antiguos conceptos relacionados con el cáncer tiroideo y han dotado de nuevas herramientas para el diagnóstico oportuno y tratamiento personalizado.

Introduction: Since the beginning of this century there has been a notable increase worldwide in the incidence rate of thyroid cancer, which generally has a latent and asymptomatic course. Objectives: To deepen the knowledge of the novel aspects of timely diagnosis and treatment of thyroid cancer. Development: Thyroid cancer is the most frequent malignant disease of the endocrine system. In recent decades, its incidence has increased rapidly, although mortality has remained low. The discovery and development of new imaging, immunological and molecular techniques have made it possible to study thyroid neoplasm in depth. This has favored advancing in the aspects that have most modified the new attitude regarding timely diagnosis and its treatment. Conclusions: In recent years, advances in basic, clinical and translational research have transformed old concepts related to thyroid cancer and have equipped with new tools for timely diagnosis and personalized treatment.

Joint Recommendations From The Latin American Association of Cardiac and Endovascular Surgery (LACES) and The Cardiovascular Anesthesia Committee of The Latin American Confederation of Anesthesia Societies (CLASA) on the Timing for Cardiac Surgery After COVID-19 Infection

ABSTRACT Introduction: Since the coronavirus disease 2019 (COVID-19) pandemic, cardiac surgeries in patients with previous infection by COVID-19 were suspended or postponed, which led to surgeries performed in patients with an advanced stage of their disease and an increase in the waiting list. There is a heterogeneous attitude in Latin America on the optimal timing to cardiac surgery in patients with previous COVID-19 infection due to scarce data on its outcome. Two Latin American associations joined to establish common suggestions on the optimal timing of surgery in patients with previous COVID-19 infection. Methods: Data collection was performed using a pre-established form, which included year of publication, objective, type of study (prospective/retrospective, descriptive/analytical), number of patients, year of study, waiting time between infection and surgery, type of surgery, morbidity, mortality, and conclusions regarding the association between mortality and morbidity. Final recommendations were approved by the board of directors of Latin American Association of Cardiac and Endovascular Surgery (LACES) and Latin American Confederation of Anesthesia Societies (CLASA). Results: Of the initial 1,016 articles, 11 comprised the final selection. Only six of them included patients who underwent cardiac surgery. According to the analyzed literature, optimal timing for cardiac surgery needs to consider the following aspects: deferable surgery, symptomatic COVID-19 infection, completeness of COVID-19 vaccination. Conclusion: These recommendations derive from the analysis of the scarce literature published at present on outcomes after cardiac surgery in patients with previous COVID-19 infection. These are to be taken as a dynamic recommendation in which Latin American reality was taken into consideration.

Queuing Dynamics and Beneficiary Satisfaction in The OPD Of a Tertiary Care Centre in Bankura, West Bengal

Context/Background: Queuing, a major problem faced by beneficiaries availing services in public health care system, may also have influence on the level of satisfaction among beneficiaries. Aims/Objectives: To describe the queuing dynamics in the OPD, to explore different factors influencing the level of satisfaction among the beneficiaries and their perception regarding possible ways to improve the queuing situation. Methodology: A hospital-based analytical study was conducted in an OPD of Bankura Sammilani Medi-cal College and Hospital, West Bengal, among 202 beneficiaries. Data were collected from subjects, se-lected from random queue in total 30 shifts (30 minutes each) on different working days, using prede-signed, pretested, questionnaire.Results: Queuing dynamics revealed utilization factor of 75%, while 25% probability of the system be-ing idle. Only 39.1% of the subjects were satisfied with the service in Paediatric OPD, in context of wait-ing in queue. MLR revealed subjects waiting in queue for a duration ≤ 1 hour and those with > 4 minutes consultation time were found to be more satisfied. Conclusions: Considering variable consultation time, arrival and service rates at the OPDs and re-sources, a well-planned system can minimize the waiting time and thus improve the level of satisfaction among the beneficiaries.

Tiempos de espera de pacientes programados en un servicio de ecografía de consulta externa / Scheduled patient waiting times in an outpatient ultrasound service

INTRODUCCIÓN: la seguridad social se encarga de la atención médica de los trabajadores asalariados. OBJETIVOS: determinar los tiempos de espera en las programaciones de ecografía y conocer el nivel de satisfacción de pacientes asegurados en el Policonsultorio 20 de octubre de la Caja Petrolera de Salud. MÉTODOS: estudio descriptivo de corte transversal y cuantitativo. Se seleccionaron 1110 solicitudes de las gestiones 2012 ­ 2014 y 1110 pacientes que tenían su solicitud de ecografía en programación actual. Se revisó los expedientes clínicos y archivos de ecografía y se realizó cuestionarios estandarizados con escala Likert a los pacientes para medir el nivel de satisfacción. RESULTADOS: el 26% de los pacientes esperaron de 4.1 a 5.1 semanas (29-35 días), existieron 2.2 solicitudes de ecografía por cada paciente, el 93% de los pacientes no está nada o poco satisfecho con los periodos de espera y el 58% considera aceptable esperar entre 1.1 a 2.0 semanas (2-14 días) para la realización del estudio. DISCUSIÓN: se deben realizar acciones que mejoren la calidad de atención y satisfacción del paciente, una de ellas es disminuir los periodos de espera en las programaciones de ecografía.

INTRODUCTION: social security provides medical care for salaried workers. OBJECTIVES: to determine waiting times for scheduled ultrasound appointments and the level of satisfaction of insured patients at Policonsultorio 20 octubre, Caja Petrolera the Salud. METHODS: this is a descriptive, cross sectional, quantitative study. One thousand one hundred and ten ultrasounds orders from the 2012 ­ 2014 administration and 1110 patients who had ultrasounds orders currently scheduled were selected for review. Clinical records and ultrasounds files were reviewed and patients answers using a standardized questionnaire using the Likert scale were used to measure their level of satisfaction. RESULTS: twenty-six percent of the patients waited 4.1 to 5.1 weeks (29-35 days), there were 2.2 ultrasounds orders per patient, 93% of the patients are somewhat or completely dissatisfied with the waiting times, and 58% consider it acceptable to wait from 1.1 to 2.0 weeks (2-14 days) to undergo the study. DISCUSSION: Actions are needed to improve the quality of care and patient satisfaction, one of which is to shorten waiting times for scheduled ultrasound.