Cost-effectiveness of moderate-to-severe psoriasis biologic treatments in Brazilian private healthcare system: cost-per-responder results derived from a network metanalysis / Custo-efetividade do tratamento biológico para psoríase moderada a grave no sistema brasileiro de saúde suplementar: resultados de custo por resposta obtidos por meio de uma metanálise em rede

Objective: To assess the cost-per-responder (CpR) of biologic therapies available in Brazil to treat moderate-to-severe plaque psoriasis (PsO) from the private healthcare system's perspective. Methods: Number needed to treat (NNT) and (CpR) analyses were performed to evaluate biologic therapies' cost-effectiveness for moderate-to-severe PsO available in Brazil. The effectiveness of biologic treatments for moderate-to-severe PsO was assessed based on a previously published metanalysis, which included studies considering PsO patients and outcomes of interest (PASI 75, 90, and 100). The clinical efficacy data in terms of estimated NNT based on the network metanalysis (NMA) results were combined with drug treatment costs to determine the CpR for each treatment arm in 3-time horizons: the primary response period, 1-year, and 2-years. Results: Risankizumab was the most cost-effective option when NMA base case scenario data was used to calculate NNT in all PASI response for both the primary response period and 1- and 2-years follow-up durations. Differences in CpR between risankizumab and other biologic drugs increased with more significant PASI improvements. CpR sensitivity analysis also confirmed these findings, indicating that risankizumab has a better performance for PASI 100, and both risankizumab and guselkumab are very similar in terms of cost per additional PASI 75 and PASI 90 responder. Conclusions: Risankizumab was estimated to have a lower cost per PASI 75, 90, and 100 responders in most simulated scenarios (primary response period [12-16 weeks], 1-year and 2-years), among the evaluated biologic therapies.

Objetivo: Avaliar o custo por respondedor (CpR) das terapias biológicas disponíveis no Brasil para tratamento da psoríase em placas (PsO) moderada a grave, na perspectiva do sistema brasileiro de saúde suplementar. Métodos: Foram realizadas análises de número necessário para tratar (NNT) e CpR para avaliar o custo-efetividade das terapias biológicas para PsO moderada a grave disponíveis no Brasil. A eficácia foi avaliada por meio de dados de uma metanálise em rede (NMA), que incluiu estudos considerando pacientes com PsO moderada a grave e os desfechos de interesse (PASI 75, 90 e 100). Dados de eficácia em termos de NNT foram combinados com custos do tratamento medicamentoso para determinar o CpR para cada braço de tratamento em três horizontes temporais: período de resposta primária, 1 ano e 2 anos. Resultados: Risanquizumabe foi mais econômico quando utilizados os dados do caso-base para calcular o NNT, considerando todos os escores PASI para o período de resposta primária e em 1 e 2 anos. As diferenças no CpR entre o risanquizumabe e os outros medicamentos biológicos aumentaram com maiores ganhos de PASI. O CpR calculado pela análise de sensibilidade confirmou esses achados, indicando que risanquizumabe tem um melhor desempenho para PASI 100, e risanquizumabe e guselcumabe são muito semelhantes em termos de CpR por PASI 75 e PASI 90 adicionais. Conclusões: Risanquizumabe apresentou um custo mais baixo por respondedor PASI 75, 90 e 100 na maioria dos cenários analisados (período de resposta primária [12-16 semanas], 1 ano e 2 anos), entre as terapias biológicas avaliadas.

Percepção Discente sobre o Ambiente Educacional da Disciplina de Semiologia Médica / Student's Perception of the Educational Environment within the Medical Semiology Subject

Resumo: Introdução: A Faculdade de Medicina da Universidade Federal de Goiás (FM-UFG) iniciou um novo processo de mudança curricular em 2014. As disciplinas de Semiologia I e II passaram a adotar metodologias ativas de ensino para adequação às necessidades da reforma curricular. O objetivo deste artigo foi avaliar a percepção dos discentes do primeiro ano da FM-UFG sobre o ambiente educacional das disciplinas de Semiologia I e II. Método: Trata-se de um estudo descritivo, do tipo corte transversal, envolvendo 86 alunos. O instrumento de coleta de dados foi o questionário Dundee Ready Education Environment Measure (Dreem), versão em português. Os resultados foram considerados em três níveis: questões individuais, cinco dimensões e Dreem global. Calcularam-se a média, o desvio padrão e os respectivos intervalos de confiança de 95%. Obteve-se a confiabilidade interna do Dreem pelo cálculo do alfa de Cronbach, avaliou-se a distribuição dos dados da amostra pelo teste de Shapiro-Wilk e realizou-se a comparação entre os percentuais da média dos escores dos domínios e do DRREM global pela ANOVA, seguida do teste de Tukey. Resultados: A média do Dreem global foi de 134,83/200 ± 17,42, uma percepção mais positiva que negativa. As cinco dimensões tiveram os seguintes resultados: percepção da aprendizagem (32,74 / 48 ± 5,59 / uma visão mais positiva); percepção dos docentes (32,71 / 44 ± 6,23 / na direção certa); percepção dos resultados acadêmicos (20,22 / 32 ± 4,09 / sentimento positivo); percepção do ambiente geral (31,74 / 48 ± 5,69 / atitude positiva); percepção das relações sociais (17,42 / 28 ± 3,83 / não é tão ruim). Foram encontrados alguns pontos problemáticos em relação a fatos memorizáveis, metodologia de ensino prévio e cansaço para cursarem a disciplina. A dimensão com mais áreas fortes foi a percepção dos docentes. Houve significância estatística quando os percentuais da média dos escores dos domínios e do Dreem global foram comparados. Conclusão: O ambiente educacional das disciplinas de Semiologia I e II da Faculdade de Medicina da UFG criado pelas inovações metodológicas foi avaliado positivamente pelos discentes participantes, com destaque para o domínio percepção dos docentes.

Abstract: Introduction: In 2014, the Medical School of the Federal University of Goias (FM-UFG) started its curricular changing process. The disciplines of Semiology I and II started to use active teaching methodologies to fit the curricular reform needs. The objective of this article was to evaluate the FM-UFG students' perception of the Educational Environment in the disciplines of Semiology I and II. Method: This is a descriptive, cross-sectional study encompassing 86 students. The data collection tool was the Dundee Ready Education Environment Measure (DREEM) questionnaire, in its Portuguese version. Results were considered at three levels: individual questions, five domains and global DREEM. Mean values, standard deviation and respective 95% confidence intervals were calculated. The internal reliability of the DREEM was determined using Cronbach's alpha; the sample normality was determined using the Shapiro-Wilk test; and the comparison between the mean score percentages of the domains and of the global DREEM was performed by ANOVA ,followed by Tukey's test. Results: The global DREEM mean was 134.83 / 200 ± 17.42, a more positive than negative perception. The five domains showed the following results: Students' Perception of Learning - SPL (32.74 / 48 ± 5.59 / a more positive approach); Students' Perception of Teachers - SPT (32.71 / 44 ± 6.23 / going in the right direction); Students' Academic Self-Perception - SASP: (20.22 / 32 ± 4.09 / feeling more on the positive side); Students' Perception of the Atmosphere - SPA (31.74 / 48 ± 5.69 / a more positive attitude); Students' Social Self-Perception - SSSP: (17.42 / 28 ± 3.83 / not too bad). Some issues were found in relation to: memorizable facts; previous teaching methodology; and, fatigue to attend the discipline. The SPT was the domain with the largest number of strong areas. Statistical significance was found when comparing the mean score percentages of the domains and the global DREEM. Conclusion: Students positively evaluated the educational environment in the subjects Semiology I and II created by the new active teaching methodologies adopted by the institution, with the SPT domain being highlighted.

Comparative efficacy of alternative handwashing versus alcoholic rub with current protocol and current usage patterns among healthcare workers

Hand hygiene is a primary mechanism for reducing contact transmission of infectious agents. We evaluated the efficacy of hand hygiene agents under condition in which they are currently being used by healthcare workers. A total of forty Healthcare Workers (HCWs) and office workers in a teaching hospital washed their hands with procedures using soap and water, and alcohol-based gel, with and without standardized protocols. A total numbers of colony - forming units on the hands were 3.52 and 4.48 for the HCWs and non-patient staff hands, respectively (p< 0.05). The average reduction in the number of organisms before and after hand hygiene of any procedures showed always statistically significant differences by both standardized and non-standardized procedures, and they all demonstrated similar results when compared to each other, with only two exceptions. There was no difference in the proportion of HCWs or non-patient staff with Staphylococcus aureus and Gram- negative rods on their hands. This study demonstrated that the regular usage of alcohol gel is as good as handwashing with soap and water, and could increase compliance in the hand hygiene, especially in situations where there is a lack of sinks or HCWs are overworked.