Selección de hospital destino para el traslado de urgencia de pacientes / Selecting the Destination Hospital to Carry Emergency Patients / Escolha de hospital alvo para traslado de urgência de pacientes

Resumen El tiempo total de atención prehospitalaria (APH) es el tiempo que transcurre desde que ingresa la llamada al operador hasta que la ambulancia queda disponible para atender otra emergencia. Esta investigación pretende demostrar que la selección del hospital destino afecta de manera significativa el tiempo total de APH, lo que influye en la supervivencia del paciente que es trasladado y en el tiempo de liberación del recurso (ambulancias). En consecuencia, se propone una técnica de selección de hospital destino que incluye dimensiones relacionadas con el paciente (diagnóstico, especialidad y asegurador) y el hospital (ocupación y cercanía). Se evalúa su desempeño por medio de una simulación de eventos discretos y se concluye que la técnica propuesta obtiene un mejor tiempo de APH en el 73% de los casos estudiados, con una reducción media entre 40 y 80 minutos, en comparación con la técnica más comúnmente usada (selección hospital más cercano).

Abstract Total time of prehospital care (PHC) is the time elapsing from the inbound call up to the moment when the ambulance is available for serve in another emergency event. This research aims to show that selecting the destination hospital impacts significantly the total PHC time, which influences the survival of the patient being transported as well as the time to make the resource available again (the ambulance). Consequently, a technique for selecting the destination hospital is proposed herein including some dimensions related both to the patient (diagnosis, specialty and insurance company) and to the hospital (occupancy and closeness). The performance was evaluated based on a simulation of discrete events. It is concluded that the proposed technique provides a better PHC time in 73% of the studied cases, with a mean decrease between 40 and 80 minutes as compared to the most commonly used technique (selecting the closest hospital).

Resumo O tempo total de atendimento pré-hospitalar (APH) é o tempo decorrente desde que a ligação for feita para o telefonista até a ambulância se disponibilizar para atender outra emergência. Esta pesquisa visa demostrar que a escolha do hospital alvo afeta significativamente o tempo total de APH, o que influi na sobrevida do paciente trasladado e no tempo de liberação do recurso (ambulâncias). Consequentemente, propõe-se uma técnica de escolha de hospital alvo que inclui dimensões relacionadas com paciente (diagnóstico, especialidade e assegurador) e hospital (ocupação e proximidade). Avalia-se o desempenho por meio de simulação de eventos discretos e conclui-se que a técnica proposta obtém melhor tempo de APH em 73% dos casos estudados com redução media entre 40 e 80 minutos, em comparação com a técnica mais comumente usada (escolha hospital mais próximo).

Teoría de colas aplicada al estudio del sistema de servicio de una farmacia / Queueing theory applied to the study of the service system of a pharmacy

Con frecuencia las instituciones que brindan servicios deben tomar decisiones respecto al caudal de clientes que reciben, así como la capacidad de servicio con que cuentan. Sin embargo, a diario se presenta un fenómeno común y cotidiano: las colas o líneas de espera, las que se generan cuando la demanda excede a la oferta. En este contexto aparece la teoría de colas, la cual no resuelve el problema, pero ofrece información para tomar decisiones, sobre la base de la predicción de algunas características sobre la cola y el sistema de servicio. Un escenario evidente en el sector salud, donde se generan constantemente líneas de espera son las farmacias. En la Farmacia Hospitalaria Principal de Santiago de Cuba, se modeló la venta de medicamentos desde este enfoque, al no contar con otras herramientas que con su aplicación apoyaran la toma de decisiones. Por ello el objetivo del trabajo es determinar desde el enfoque de la teoría de colas, las variables y medidas de rendimiento del sistema de servicio de dicha Farmacia, para la toma de decisiones a corto y mediano plazo, en función de ofrecer un mayor y mejor servicio. Como resultado se determinó que, para el sistema de servicio actual, existe una alta probabilidad de que se generen colas, y que los clientes permanezcan en ella por más de 5 minutos; recomendando garantizar la disponibilidad de los dependientes, reducir el número de clientes en la cola, hacer más amena la estancia en ella, así como valorar y evaluar su rediseño(AU)

Often the institutions that provide services must make decisions regarding the number of clients they receive, as well as the service capacity they have. However, there is a daily and everyday phenomenon: queues or waiting lines, which are generated when demand exceeds supply. In this context, queueing theory appears, which does not solve the problem, but provides information needed to make decisions, based on the prediction of some characteristics about the queue and the service system. A clear context in the health branch, where there are constantly waiting lines are pharmacies. In the Municipal Community Pharmacy of Santiago de Cuba, the sale of medicinal products was modeled from this approach, since there are no other applied tools that support decision making. Therefore, the objective of the work is to determine from the approach of queueing theory, the variables and measures of performance of the service system of the said Pharmacy, for the decision making in the short and medium term, in function of offering a greater and better service. As a result, it was determined that, for the current service system, there is a high probability that queues will be generated, and that customers will stay in it for more than 5 minutes; recommending to guarantee the availability of dependents, reduce the number of clients in the queue, make the stay in it more enjoyable, as well as assess and evaluate its redesign(AU)

Teoría de colas aplicada al estudio del sistema de servicio de una farmacia / Queueing theory applied to the study of the service system of a pharmacy

Con frecuencia las instituciones que brindan servicios deben tomar decisiones respecto al caudal de clientes que reciben, así como la capacidad de servicio con que cuentan. Sin embargo, a diario se presenta un fenómeno común y cotidiano: las colas o líneas de espera, las que se generan cuando la demanda excede a la oferta. En este contexto aparece la teoría de colas, la cual no resuelve el problema, pero ofrece información para tomar decisiones, sobre la base de la predicción de algunas características sobre la cola y el sistema de servicio. Un escenario evidente en el sector salud, donde se generan constantemente líneas de espera son las farmacias. En la Farmacia Hospitalaria Principal de Santiago de Cuba, se modeló la venta de medicamentos desde este enfoque, al no contar con otras herramientas que con su aplicación apoyaran la toma de decisiones. Por ello el objetivo del trabajo es determinar desde el enfoque de la teoría de colas, las variables y medidas de rendimiento del sistema de servicio de dicha Farmacia, para la toma de decisiones a corto y mediano plazo, en función de ofrecer un mayor y mejor servicio. Como resultado se determinó que, para el sistema de servicio actual, existe una alta probabilidad de que se generen colas, y que los clientes permanezcan en ella por más de 5 minutos; recomendando garantizar la disponibilidad de los dependientes, reducir el número de clientes en la cola, hacer más amena la estancia en ella, así como valorar y evaluar su rediseño(AU)

Often the institutions that provide services must make decisions regarding the number of clients they receive, as well as the service capacity they have. However, there is a daily and everyday phenomenon: queues or waiting lines, which are generated when demand exceeds supply. In this context, queueing theory appears, which does not solve the problem, but provides information needed to make decisions, based on the prediction of some characteristics about the queue and the service system. A clear context in the health branch, where there are constantly waiting lines are pharmacies. In the Municipal Community Pharmacy of Santiago de Cuba, the sale of medicinal products was modeled from this approach, since there are no other applied tools that support decision making. Therefore, the objective of the work is to determine from the approach of queueing theory, the variables and measures of performance of the service system of the said Pharmacy, for the decision making in the short and medium term, in function of offering a greater and better service. As a result, it was determined that, for the current service system, there is a high probability that queues will be generated, and that customers will stay in it for more than 5 minutes; recommending to guarantee the availability of dependents, reduce the number of clients in the queue, make the stay in it more enjoyable, as well as assess and evaluate its redesign(AU)

How do low-birthweight neonates fare 2 years after discharge from a low-technology neonatal care unit in a rural district hospital in Burundi?

OBJECTIVES: As neonatal care is being scaled up in economically poor settings, there is a need to know more on post-hospital discharge and longer-term outcomes. Of particular interest are mortality, prevalence of developmental impairments and malnutrition, all known to be worse in low-birthweight neonates (LBW, <2500 g). Getting a better handle on these parameters might justify and guide support interventions. Two years after hospital discharge, we thus assessed: mortality, developmental impairments and nutritional status of LBW children. METHODS: Household survey of LBW neonates discharged from a neonatal special care unit in Rural Burundi between January and December 2012. RESULTS: Of 146 LBW neonates, 23% could not be traced and 4% had died. Of the remaining 107 children (median age = 27 months), at least one developmental impairment was found in 27%, with 8% having at least five impairments. Main impairments included delays in motor development (17%) and in learning and speech (12%). Compared to LBW children (n = 100), very-low-birthweight (VLBW, <1500 g, n = 7) children had a significantly higher risk of impairments (intellectual - P = 0.001), needing constant supervision and creating a household burden (P = 0.009). Of all children (n-107), 18% were acutely malnourished, with a 3½ times higher risk in VLBWs (P = 0.02). CONCLUSIONS: Reassuringly, most children were thriving 2 years after discharge. However, malnutrition was prevalent and one in three manifested developmental impairments (particularly VLBWs) echoing the need for support programmes. A considerable proportion of children could not be traced, and this emphasises the need for follow-up systems post-discharge.

Metodología lúdica para la enseñanza de la programación dinámica determinista en un contexto universitario

En este artículo se presentan los resultados de un proceso investigativo desarrollado por el Grupo en la Enseñanza de la Investigación de Operaciones (GEIO), perteneciente a la Facultad de Ingeniería Industrial de la Universidad Tecnológica de Pereira - Colombia, en donde la lúdica es planteada como metodología de enseñanza para generar micromundos que permitieran a estudiantes del ámbito universitario interiorizar conceptos matemáticos difíciles de comprender por métodos reduccionistas. La investigación documentada se desarrolló con un grupo de alumnos de la Facultad de Ingeniería Industrial, con los cuales se trabajó el concepto de programación dinámica determinista, enfocada al balanceo de línea empleando una lúdica de un proceso productivo textil. La aplicación práctica fue evaluada mediante el proceso de validación de expertos y permitió concluir que la metodología lúdica propuesta por GEIO es clara, pertinente, viable, coherente y constituye una herramienta para representar sistemas reales, donde los estudiantes pueden asociar fácilmente conceptos teóricos a situaciones prácticas, llegando a generar aprendizaje significativo gracias a la interacción del participante con el contexto simulado.

In this article the results of a research process developed by the Group in the Teaching of Operations Research (GEIO) belonging to the Faculty of Engineering of the Technological University of Pereira - Colombia are presented, where the hands on activities are raised as teaching methodology to generate micro-worlds that would allow university students to internalize mathematical concepts that are difficult to understand by reductionist methods. The documented investigation was developed with a group of students from the Faculty of Industrial Engineering, with they was worked the concept of deterministic dynamic programming focused on balancing line using hands on activity of a textile production process. The above evidence was evaluated with the validation process by experts, and it allowed to conclude the hands on activity methodology proposed by GEIO is clear relevant, viable, coherent and is a tool to represent real systems where students can easily associate theoretical concepts to practical situations, reaching generate learning significant thanks to the interaction of the participant with the simulated context.

Este artigo apresenta os resultados de um processo de pesquisa desenvolvido pelo Grupo sobre o Ensino de Pesquisa Operacional (GEIO), pertencente À Faculdade de Engenharia da Universidade Tecnológica de Pereira são apresentados - Colômbia, onde a diversão é levantada como metodologia de ensino para gerar microworlds que permitiriam que os estudantes das universidades internalizar difícil de entender conceitos matemáticos métodos reducionistas. pesquisa documentada foi realizada com um grupo de estudantes da Faculdade de Engenharia Industrial, com a qual o conceito de programação dinâmica determinista trabalhou, focado no equilíbrio utilizando uma linha lúdica de um processo de produção têxtil. A aplicação prática foi avaliada pelo perito processo de validação e permitiram concluir que a metodologia lúdica proposto por GEIO é clara, relevante e viável, coerente e é uma ferramenta para representar sistemas reais, onde os alunos podem facilmente associar conceitos teóricos a situações práticas, chegando a gerar aprendizagem significativa por meio da interação dos participantes com o contexto simulado.

HIV testing uptake and retention in care of HIV-infected pregnant and breastfeeding women initiated on 'Option B+' in rural Zimbabwe.

OBJECTIVES: Zimbabwe has started to scale up Option B+ for the prevention of mother-to-child transmission of HIV, but there is little published information about uptake or retention in care. This study determined the number and proportion of pregnant and lactating women in rural districts diagnosed with HIV infection and started on Option B+ along with six-month antiretroviral treatment (ART) outcomes. METHODS: This was a retrospective record review of women presenting to antenatal care or maternal and child health services at 34 health facilities in Chikomba and Gutu rural districts, Zimbabwe, between January and March 2014. RESULTS: A total of 2728 women presented to care of whom 2598 were eligible for HIV testing: 76% presented to antenatal care, 20% during labour and delivery and 4% while breastfeeding. Of 2097 (81%) HIV-tested women, 7% were HIV positive. Lower HIV testing uptake was found with increasing parity, late presentation to antenatal care, health centre attendance and in women tested during labour. Ninety-one per cent of the HIV-positive women were started on Option B+. Six-month ART retention in care, including transfers, was 83%. Loss to follow-up was the main cause of attrition. Increasing age and gravida status ≥2 were associated with higher six-month attrition. CONCLUSION: The uptake of HIV testing and Option B+ is high in women attending antenatal and post-natal clinics in rural Zimbabwe, suggesting that the strategy is feasible for national scale-up in the country.

The rise and fall of tuberculosis in Malawi: associations with HIV infection and antiretroviral therapy.

OBJECTIVES: Since 1985, Malawi has experienced a dual epidemic of HIV and tuberculosis (TB) which has been moderated recently by the advent of antiretroviral therapy (ART). The aim of this study was to describe the association over several decades between HIV/AIDS, the scale-up of ART and TB case notifications. METHODS: Aggregate data were extracted from annual reports of the National TB Control Programme, the Ministry of Health HIV Department and the National Statistics Office. ART coverage was calculated using the total HIV population as denominator (derived from UNAIDS Spectrum software). RESULTS: In 1970, there were no HIV-infected persons but numbers had increased to a maximum of 1.18 million by 2014. HIV prevalence reached a maximum of 10.8% in 2000, thereafter decreasing to 7.5% by 2014. Numbers alive on ART increased from 2586 in 2003 to 536 527 (coverage 45.3%) by 2014. In 1985, there were 5286 TB cases which reached a maximum of 28 234 in 2003 and then decreased to 17 723 by 2014 (37% decline from 2003). There were increases in all types of new TB between 1998-2003 which then declined by 30% for extrapulmonary TB, by 37% for new smear-positive PTB and by 50% for smear-negative PTB. Previously treated TB cases reached a maximum of 3443 in 2003 and then declined by 42% by 2014. CONCLUSION: The rise and fall of TB in Malawi between 1985 and 2014 was strongly associated with HIV infection and ART scale-up; this has implications for ending the TB epidemic in high HIV-TB burden countries.

Medication Adherence Clubs: a potential solution to managing large numbers of stable patients with multiple chronic diseases in informal settlements.

OBJECTIVES: To assess the care of hypertension, diabetes mellitus and/or HIV patients enrolled into Medication Adherence Clubs (MACs). METHODS: Retrospective descriptive study was carried out using routinely collected programme data from a primary healthcare clinic at informal settlement in Nairobi, Kenya. All patients enrolled into MACs were selected for the study. MACs are nurse-facilitated mixed groups of 25-35 stable hypertension, diabetes mellitus and/or HIV patients who met quarterly to confirm their clinical stability, have brief health discussions and receive medication. Clinical officer reviewed MACs yearly, when a patient developed complications or no longer met stable criteria. RESULTS: A total of 1432 patients were enrolled into 47 clubs with 109 sessions conducted between August 2013 and August 2014. There were 1020 (71%) HIV and 412 (29%) non-communicable disease patients. Among those with NCD, 352 (85%) had hypertension and 60 (15%) had DM, while 12 had HIV concurrent with hypertension. A total of 2208 consultations were offloaded from regular clinic. During MAC attendance, blood pressure, weight and laboratory testing were completed correctly in 98-99% of consultations. Only 43 (2%) consultations required referral for clinical officer review before their routine yearly appointment. Loss to follow-up from the MACs was 3.5%. CONCLUSIONS: This study demonstrates the feasibility and early efficacy of MACs for mixed chronic disease in a resource-limited setting. It supports burden reduction and flexibility of regular clinical review for stable patients. Further assessment regarding long-term outcomes of this model should be completed to increase confidence for deployment in similar contexts.

Good clinical outcomes from a 7-year holistic programme of fistula repair in Guinea.

OBJECTIVES: Female genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country. METHODS: This was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014. RESULTS: The majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n = 2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (85%) had a closed fistula and 1680 (79%) were dry, meaning they no longer leaked urine and/or faeces. One hundred and fifteen (5%) remained with residual incontinence despite fistula closure. Follow-up at 3 months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistula closed and 80% were continent. Twenty-one per cent were lost to follow-up. CONCLUSION: Routine programmatic repair for obstetric fistula in low resources settings can yield good outcomes. However, more efforts are needed to address loss to follow-up, sustain the results and prevent the occurrence and/or recurrence of fistula.

Ebola outbreak in rural West Africa: epidemiology, clinical features and outcomes.

OBJECTIVE: To describe Ebola cases in the district Ebola management centre of in Kailahun, a remote rural district of Sierra Leone, in terms of geographic origin, patient and hospitalisation characteristics, treatment outcomes and time from symptom onset to admission. METHODS: Data of all Ebola cases from June 23rd to October 5th 2014 were reviewed. Ebola was confirmed by reverse-transcriptase-polymerase-chain-reaction assay. RESULTS: Of 489 confirmed cases (51% male, median age 28 years), 166 (34%) originated outside Kailahun district. Twenty-eight (6%) were health workers: 2 doctors, 11 nurses, 2 laboratory technicians, 7 community health workers and 6 other cadres. More than 50% of patients had fever, headache, abdominal pain, diarrhoea/vomiting. An unusual feature was cough in 40%. Unexplained bleeding was reported in 5%. Outcomes for the 489 confirmed cases were 227 (47%) discharges, 259 (53%) deaths and 3 transfers. Case fatality in health workers (68%) was higher than other occupations (52%, P = 0.05). The median community infectivity time was 6.5 days for both general population and health workers (P = 0.4). CONCLUSIONS: One in three admitted cases originated outside Kailahun district due to limited national access to Ebola management centres - complicating contact tracing, safe burial and disinfection measures. The comparatively high case fatality among health workers requires attention. The community infectivity time needs to be reduced to prevent continued transmission.

Cómo publicar artículos de gestión en salud en revistas de gerencia de alto índice de impacto / How to Publish Papers on Healthcare Management in High Impact Management Reviews / Como publicar artigos de gestão em saúde em revistas de gerência de alto índice de impacto

El proceso de publicar una investigación como un trabajo científico es el último eslabón de la cadena de investigación. Intentar publicar es un proceso largo y desgastante, que en muchas ocasiones no termina en éxito. En revistas de alto impacto en el área de gerencia, donde se publican trabajos originales relacionados con el área de la salud, solo pasan a primera ronda de revisión de pares el 10% de los artículos y logran ser publicados apenas el 5% del total de trabajos sometidos a revisión. En el siguiente trabajo se exponen algunos consejos útiles, que pueden contribuir a que sus trabajos se encuentren en ese selecto 5% . Si bien (se dará cuenta) es difícil, no es imposible.

Publishing scientific papers is the last process in the research chain. Publishing is a long and exhausting process, which, in many cases, does not have a happy end. In high-impact management journals publishing original works in the health area,, only about 10% of the articles passed to the first round of peer review, and only 5% of all papers subject to review are eventually published. My paper discusses some useful tips that can help your papers to belong to that 5%-elite. Even if you find it is difficult, it is not impossible.

O processo de publicar uma pesquisa como um trabalho científico é o último processo da cadeia de pesquisa. Tentar publicar é um processo longo e desgastante, que em muitas ocasiões não termina em sucesso. Em revistas de alto impacto de management onde se publicam trabalhos originais relacionados com a área da saúde, só passam a primeira ronda de revisão de pares o 10% dos artigos e conseguem ser publicados a penas o 5% do total de trabalhos submetidos à revisão. No seguinte trabalho expõem-se alguns conselhos úteis, que podem contribuir a que seus trabalhos se encontrem nesse seleto 5%. Se bem que (será evidente) é difícil, não é impossível.

Aproximación metodológica a la planificación y a la programación de las salas de cirugía: una revisión de la literatura / Methodological approach to the planning and scheduling of operating rooms: a literature review / Aproximação metodológica à planificação e programação das salas de cirurgia: revisão de literatura

El sector hospitalario en diferentes partes del mundo se ha visto obligado a incursionar en lareducción de costos. Las salas de cirugía son uno de los departamentos más costosos de loshospitales debido a los problemas que presenta la planeación y programación de las operaciones.El presente trabajo proporciona una revisión de las diferentes investigaciones enfocadas asolucionar los problemas de la planeación de las salas de cirugía. Se realizó una clasificaciónde las técnicas de solución más utilizadas y los resultados que se consiguieron. De los ochentaartículos más recientes se encuentra que un 62 % de los trabajos abordan el problema de la reduccióndel tiempo de espera de los pacientes por ser atendidos, y que la optimización multiobjetivoestocástica es la metodología que en un 33 % de los casos se plantea como la aproximación quede manera más completa aborda todos los aspectos involucrados en el proceso de planeación,reduciendo los costos hasta en un 15 %...

The hospital sector in different parts of the world has been forced to move into cost reduction.The operating rooms are one of the most expensive departments of hospitals due to the problemspresented by planning and scheduling the operations. This paper provides an overview of thedifferent research focused on solving the problems of planning the operating rooms. We performeda classification of the solution techniques used and the results that were achieved. Of theeighty latest articles, 62% of the works deal with the problem of reducing the waiting time forpatients to be treated, and the optimization of the multiobjective stochastic is the methodologywhich in 33% of the cases arises as the approach that more fully addresses all aspects involvedin the planning process, reducing costs by up to 15%...

O setor hospitalar em diferentes partes do globo tem se visto obligado a incursionar na reduçãode custos. As salas de cirurgia são um dos departamentos mais custosos dos hospitais devidoaos problemas que apresenta o planejamento e programação das operações. O presente trabalhoproporciona revisão das diferentes pesquisas focadas a solucionar os problemas do planejamentodas salas de cirurgia. Realizou-se uma classificação das técnicas de solução mais utilizadase os resultados que se conseguiram. Dos oitenta artigos mais recentes encontra-se que um62 % dos trabalhos abordam o problema da redução do tempo de espera dos pacientes por seratendidos, e que a otimização multiobjetivo estocástica é a metodologia que, em um 33 % doscasos, esboça-se como a aproximação que de maneira mais completa aborda todos os aspectosenvolvidos no processo de planejamento, reduzindo os custos até um 15 %...

¿DISENSO ENTRE PARES REVISORES? NO SE PREOCUPE, QUE A FIN DE CUENTAS EL EDITOR SIEMPRE TIENE LA ÚLTIMA PALABRA / DISSENT BETWEEN PEER REVIEWERS? DON'T WORRY, ULTIMATELY THE EDITOR HAS THE LAST WORD

Todos hemos sometido algún artículo científico a revisión con la idea de que sea publicado en cierta revista. Frecuentemente, los autores experimentan muchas barreras para alcanzar el éxito (lograr la publicación) cuando someten artículos a revisión. Estas barreras dependen de la escritura del artículo en sí mismo, de los sesgos de los pares revisores, de la forma en que se escribe la carta de presentación (cover letter), y de la manera en la cual se implementa una estrategia para abordar y responder a las observaciones (erradas o no) que emiten los pares revisores y el editor de la revista. El propósito de este artículo vivencial es el de brindar consejos útiles a autores que investigan en el área de la ingeniería clínica, sobre cómo publicar artículos que aborden temas en el área de la salud en revistas de alto impacto en el área del operations research & management sciences.

All of us have at some point submitted a scientific paper for review with the idea of being published in a given journal. Often, the authors experience many barriers to success (achieving publication) when they submit articles for publication. These barriers depend on the quality of the writing itself, on the biases of the peer reviewers, the way you write your cover letter, and the way in which you address and respond to the observations (erroneous or not) emitted by peer reviewers and the editor of the journal. The purpose of this paper is to provide useful pieces of advice on how to publish articles that tackle issues in the health area in high impact journals in the area of Operations Research & Management Sciences.