[Bleeders and healers in Brazil (1808-28)]. / Barbeiros-sangradores e curandeiros no Brasil (1808-28).

Based on documentation from the institution known as Fisicatura-mor (1808-28), and mainly on proceedings involving its official 'accreditation' of medical activities, this analysis of popular therapists opens access to categories like bleeders and healers, who were persecuted for their activities down through the nineteenth century. The curing practices employed by these bleeders and curandeiros ranked low on the hierarchy of procedures acceptable by the Fisicatura-mor. Quantitative data analysis demonstrates a link between these practices and disadvantaged social positions. Also analyzed was information that popular therapists and their clientele provided on these practices and on how they are accepted.

Paradigm shift: phlebotomy belongs to nursing.

Defining, analyzing, and changing macro- and micro-processes has become almost a routine part of the TQM efforts of many laboratories as they strive to improve service and reduce costs. Scrutinizing each part of a process can reveal unnecessary steps that, if eliminated, would generate improvements with desired outcomes. This laboratory reviewed the processes associated with phlebotomy, especially for STAT tests, at the same time its administration was planning to establish 11 patient care centers where there previously had been three traditionally operated hospitals. Through process analysis, this laboratory transferred the entire function of in-patient phlebotomy from the laboratory to nursing. The results of an 8-month follow-up study show a significant favorable effect on laboratory turnaround time and related costs but not without some problems.

Diagnostic blood loss in the patient undergoing head and neck surgery.

OBJECTIVE: To examine retrospectively the amount of blood lost solely for diagnostic purposes in a defined group of patients. DESIGN: Retrospective medical chart review of a case series. SETTING: Operating theater and surgical intensive care unit in a major tertiary care center. PATIENTS: Thirty-nine consecutive patients with head and neck cancer undergoing major surgical procedures and requiring overnight intensive care unit monitoring. MAIN OUTCOME MEASURES: Patient medical records were analyzed for procedure, starting hematocrit reading, intraoperative estimated blood loss and intravenous fluids, operative time, history of blood product transfusion, blood lost for each phlebotomy encounter, and the immediate cost therefrom. RESULTS: The mean diagnostic blood loss was 181 mL, which was 36% of estimated blood loss. In the group of 23 nontransfused patients, the average drop in hematocrit was 9.7%. This change in hematocrit correlated most strongly with operating time (P < .02) and the amount of intraoperative intravenous fluid administration (P < .05). The average cost to the patient directly from phlebotomy-associated charges was $542. CONCLUSION: Diagnostic blood loss contributes significantly to the overall blood loss in the patient undergoing head and neck surgery.

Phlebotomy--a minimalist approach.

For each patient, laboratories usually collect more blood than is needed for specific determinations. We reviewed the amount of blood collected for laboratory measurements for an entire hospital stay of 113 patients admitted during a 1-week period to a medical ward or to a medical intensive-care unit in our tertiary-care facility. The amount of blood obtained was also compared with the minimal amount needed for analysis for 18 of the most frequently ordered laboratory tests in our facility. For routine collections, a mean of 45 times the required volume of specimen (range, 2 to 102 times) was obtained. For optimal utilization of laboratory services, both the positive and the negative consequences of testing must be thoughtfully considered. Two potential adverse effects of withdrawal of blood for laboratory determinations are iatrogenic anemia and infection. Moreover, the cost of care is increased with additional analyses. Practical strategies for decreasing the amount of blood collected include an increased awareness of ordering practices, a thorough knowledge of the volume of blood needed for each laboratory test, experienced phlebotomy personnel, storage of blood specimens for potential subsequent use, and communication of accurate minimal volumes needed for specific measurements.

Use of serum from patients with polycythaemia or haemochromatosis for laboratory external quality assurance exercises.

Some External Quality Assessment Schemes (EQAS) require large volumes of human serum. During a one year period, 595 units of blood were obtained from 87 patients with haemochromatosis and polycythaemia, who underwent therapeutic venesection at the Edinburgh and South East Scotland Blood Transfusion Service. Serum from 59% of these donations was used in the EQAS for peptide hormones and related substances. The cost of the serum collection was 109 pounds/litre, but was only 33 pounds/litre of serum if the cost of the actual venesection was excluded. Results from tests on the sera were satisfactory in a variety of immunoassays for several different hormones. EQA schemes with requirements for large volumes of serum should consider therapeutic venesection as a cost effective means of obtaining serum.

Organización del abastecimiento de medicamentos para la epidemia de cólera: informe de asesoria a la Comisión Nacional de Prevención y Control del cólera

Bases conceptuales que sustentan la organización del suministro de medicamentos para la prevención y tratamiento del cólera y la aplicación concreta de la metodología. Estimación de los volúmenes requeridos y recursos financieros necesarios en la situación de incertidumbre que caracteriza la etapa preparatoria de la epidemia, cubriendo el ámbito del país

Organización del abastecimiento de medicamentos para la epidemia de cólera: informe de asesoria a la Comisión Nacional de Prevención y Control del cólera

Bases conceptuales que sustentan la organización del suministro de medicamentos para la prevención y tratamiento del cólera y la aplicación concreta de la metodología. Estimación de los volúmenes requeridos y recursos financieros necesarios en la situación de incertidumbre que caracteriza la etapa preparatoria de la epidemia, cubriendo el ámbito del país

[Analysis of the costs and complications of different procedures for the administration of intravenous liquids]. / Análisis de costos y complicaciones de diferentes procedimientos para administración de líquidos intravenosos.

With the purpose of finding the most economical method to administer intravenous fluids, we studied 3 groups of children with different pathologies: 50 cases with peripheral intravenous lines (PIL), 50 with venesection (VD) and 50 with percutaneous silastic catheter (PC). To facilitate the cost-expense analysis, each procedure was standardized to a "PIL unit". We found that PIL is the less expensive when IV fluids are administered for over periods of less than 5 days; even though we had an index failure of 24%. The PC has a low cost easy to place and with the advantage that can be established centrally for the measurement of central venous pressure, administration of hypertonic solutions or total parenteral nutrition. Preserving the vascular lumen when it is withdrawn, and resulting as an ideal method when administering fluids for for more than 5 days. VD must be left as a last resource, given its cost and because generally this ruins permanently the vein employed. Complications observed in the 3 procedures were similar to those reported by other authors and there were no mayor complications observed in this study.