Performance measurement of Brazilian federal university hospitals: an overview of the public health care services through principal component analysis.

PURPOSE: This paper aimed to contextualize the process of public hospital providing services, based on the measurement of the performance of Federal University Hospitals (HUFs) of Brazil, using the technique of multivariate statistics of principal component analysis. DESIGN/METHODOLOGY/APPROACH: This research presented a descriptive and quantitative character, as well as exploratory purpose and followed the inductive logic, being empirically structured in two stages, that is, the application of principal component analysis (PCA) in four healthcare performance dimensions; subsequently, the full reapplication of principal component analysis in the most highly correlated variables, in module, with the first three main components (PC1, PC2 and PC3). FINDINGS: From the principal component analysis, considering mainly component I, with twice the explanatory power of the second (PC2) and third components (PC3), it was possible to evidence the efficient or inefficient behavior of the HUFs evaluated through the production of medical residency, by specialty area. Finally, it was observed that the formation of two groups composed of seven and eight hospitals, that is, Groups II and IV shows that these groups reflect similarities with respect to the scores and importance of the variables for both hospitals' groups. RESEARCH LIMITATIONS/IMPLICATIONS: Among the main limitations it was observed that there was incomplete data for some HUFs, which made it impossible to search for information to explain and better contextualize certain aspects. More specifically, a limited number of hospitals with complete information were dealt with for 60% of SIMEC/REHUF performance indicators. PRACTICAL IMPLICATIONS: The use of PCA multivariate technique was of great contribution to the contextualization of the performance and productivity of homogeneous and autonomous units represented by the hospitals. It was possible to generate a large quantity of information in order to contribute with assumptions to complement the decision-making processes in these organizations. SOCIAL IMPLICATIONS: Development of public policies with emphasis on hospitals linked to teaching centers represented by university hospitals. This also involved the projection of improvements in the reach of the efficiency of the services of assistance to the public health, from the qualified formation of professionals, both to academy, as to clinical practice. ORIGINALITY/VALUE: The originality of this paper for the scenarios of the Brazilian public health sector and academic area involved the application of a consolidated performance analysis technique, that is, PCA, obtaining a rich work in relation to the extensive exploitation of techniques to support decision-making processes. In addition, the sequence and the way in which the content, formed by object of study and techniques, has been organized, generates a particular scenario for the measurement of performance in hospital organizations.

Punctuated 88% Phenol Peeling for the Treatment of Facial Photoaging: A Clinical and Histopathological Study.

BACKGROUND: Phenol peeling is considered an important agent in the treatment of facial rejuvenation; however, its use has limitations due to its high potential for side effects. OBJECTIVE: This article proposes a new peeling application technique for the treatment of photoaging, aiming to evaluate, clinically and histopathologically, the efficacy of a new way of applying 88% phenol, using a punctuated pattern. METHODS: The procedure was performed in an outpatient setting, with female patients, on static wrinkles and high flaccidity areas of the face. Accompanying photographs and skin samples were taken for histopathological analysis before and after treatment. RESULTS: It was shown that 88% phenol applied topically using a punctuated technique is effective in skin rejuvenation. CONCLUSION: The authors thus suggest, based on this new proposal, that further studies be conducted with a larger group of patients to better elucidate the action mechanisms of 88% phenol. This new form of application considerably reduced patients' withdrawal from their regular activities, besides reducing the cost, compared with the conventional procedure.

The West Kingston/Tivoli Gardens Incursion in Kingston, Jamaica.

On May 24, 2010, 800 soldiers and 370 police officers stormed into Tivoli Gardens, an impoverished district in the capital of Jamaica. Their aim was to restore state authority in this part of Kingston and to arrest Christopher "Dudus" Coke, who was wanted for extradition to the United States on drug and arms trafficking charges. The incursion was the culmination of nine months of national political turmoil. The first aim was achieved, but the second was not, and only at great cost. Around 70 civilians and three members of the security forces were killed. The authors constituted a small group of international forensic pathologists who, at the request of the Public Defender and over a four-week period from mid-June, observed the autopsies of the civilians. This paper describes some of the outcomes of this work, set within the evaluation of the incursion by the Commission of Enquiry. The Enquiry concluded there was evidence of at least 15 extrajudicial killings and was highly critical of many other aspects of the operation and its aftermath.

Técnica minimamente invasiva para correção de lóbulo de orelha totalmente fendido / Minimally invasive technique for repairing complete earlobe cleft

Devido a algumas limitações nas técnicas cirúrgicas de correção de lóbulo de orelha fendido, como cicatrizes inestéticas e recidivas, os autores descrevem técnica corretiva minimamente invasiva com base em ponto único de sutura simples, seguido de aplicação de ácido tricloroacético a 90%. Devido à facilidade técnica do procedimento, baixo custo e ótimos resultados, a técnica descrita deve ser considerada opção terapêutica para a correção de lóbulos de orelha totalmente fendidos.Devido a algumas limitações nas técnicas cirúrgicas de correção de lóbulo de orelha fendido, como cicatrizes inestéticas e recidivas, os autores descrevem técnica corretiva minimamente invasiva com base em ponto único de sutura simples, seguido de aplicação de ácido tricloroacético a 90%. Devido à facilidade técnica do procedimento, baixo custo e ótimos resultados, a técnica descrita deve ser considerada opção terapêutica para a correção de lóbulos de orelha totalmente fendidos.

Histopathological aspects of cutaneous photoaging and phenol peeling

The skin is regarded as the largest organ in our system and has the general purposes of physical, mechanical and immunological protection, sealing against the elements and thermoregulation and tactile perception of environmental stimuli. Skin aging is a complex biological event that affects all skin layers. The dermis, however, is particularly affected due to its histophysiologies' characteristics. With the expansion of life expectancy, the dermatological questions among the older population has had an increasingly bigger importance, propelling the development and perfecting of rejuvenation techniques. The phenol peeling is a deep, chemical one, which offers intense clinical results. The application on small areas of the body, for example, around the eyes, is safe and does not lead to cardiovascular complications. This review aims to update the knowledge of skin histology, the alterations related to photoaging and phenol peeling.

[Oral health and perceptions regarding dental care in patients with mental disorders living in therapeutic residences]. / Saúde bucal e percepção sobre o atendimento odontológico em pacientes com transtorno psíquico moradores de residências terapêuticas.

Patients with mental disorders have considerable difficulty in access to dental care, including the refusal of oral health professionals to offer care to this clientele and the inadequate professional training of oral health professionals regarding this issue. The present study was carried out in therapeutic residences in order to assess the oral health conditions of the residents as well as their perceptions regarding the dental care they have received. Thirty-eight individuals participated in the study. Data were collected through clinical examinations and a semi-structured interview. Data analysis revealed a high number of caries and the need for dentures, with 42.5% of the individuals needing complete dentures and 30.3% needing partial dentures. Regarding periodontal conditions, 28.5% of the dental elements exhibited losses of over 4 mm of periodontal insertion. Data from the interviews were submitted to content analysis, which enabled the establishment of two categories: the association of pain with the presence of teeth and mutilating dental care. Oral health was associated to dental extraction, which was considered the only solution to oral health disturbances, indicating that, for this population, oral health signifies not having teeth.

Saúde bucal e percepção sobre o atendimento odontológico em pacientes com transtorno psíquico moradores de residências terapêuticas / Oral health and perceptions regarding dental care in patients with mental disorders living in therapeutic residences

Os pacientes portadores de transtornos psíquicos têm grande dificuldade de acesso ao tratamento dentário. Os problemas enfrentados vão desde a recusa dos profissionais em atender a essa clientela à inapropriada formação profissional dos mesmos. Este estudo, realizado em residências terapêuticas, objetivou avaliar as condições de saúde bucal dos moradores, assim como a percepção dos mesmos em relação ao atendimento odontológico recebido. Fizeram parte do estudo 38 indivíduos, sendo os dados coletados através de exame clínico e entrevista semiestruturada. A análise dos dados indicou elevado índice de cárie e de necessidade protética, com 42,5 por cento dos indivíduos necessitando de prótese total e 30,3 por cento, de próteses parciais. Com relação às condições periodontais, 28,5 por cento dos elementos dentários apresentaram perda de inserção periodontal maior que 4 mm. Os dados da entrevistas foram averiguados pela análise de conteúdo temática, possibilitando a construção de duas categorias: associação de dor com a presença de dentes e o atendimento odontológico mutilador. A presença de saúde bucal foi associada à extração dentária, sendo esta a única solução para os incômodos na boca, indicando que, para esta população, ter saúde bucal é não ter dentes.

Patients with mental disorders have considerable difficulty in access to dental care, including the refusal of oral health professionals to offer care to this clientele and the inadequate professional training of oral health professionals regarding this issue. The present study was carried out in therapeutic residences in order to assess the oral health conditions of the residents as well as their perceptions regarding the dental care they have received. Thirty-eight individuals participated in the study. Data were collected through clinical examinations and a semi-structured interview. Data analysis revealed a high number of caries and the need for dentures, with 42.5 percent of the individuals needing complete dentures and 30.3 percent needing partial dentures. Regarding periodontal conditions, 28.5 percent of the dental elements exhibited losses of over 4 mm of periodontal insertion. Data from the interviews were submitted to content analysis, which enabled the establishment of two categories: the association of pain with the presence of teeth and mutilating dental care. Oral health was associated to dental extraction, which was considered the only solution to oral health disturbances, indicating that, for this population, oral health signifies not having teeth.

Contribution of teeth in human forensic identification--discriminant function sexing odontometrical techniques in Portuguese population.

We investigate the accuracy of odontometric methods in sex determination, using a sample from the Portuguese population. Measurements were made on dental casts using a digital caliper, and various odontometric indexes have been defined using upper incisor and canine teeth. Comparison of the means in both sexes was performed using Student's t-test. Significant differences (p<0.05) were found in all variables except for the "Incisor Index". The canine showed the greatest sexual discriminant characteristics. In the presence of one or both canines the distobuccal-mesiolingual crown diameter and the "Robustness Value" allowed discrimination between sexes in the studied population. We also provide further arguments on the debate on whether sex determination is population specific.

Nonsurgical technique for incomplete earlobe cleft repair.

BACKGROUND: Earlobe cleft is a common problem caused by the wearing of jewelry or decorative objects. Incomplete earlobe clefts are usually bilateral and are often converted to complete clefts as part of the surgical repair procedure. OBJECTIVE: We present a nonsurgical procedure for incomplete earlobe cleft repair using trichloroacetic acid 90%. METHODS AND MATERIALS: We assessed 32 patients with a total of 53 earlobes to be noninvasively repaired. RESULTS: Complete treatment varied from 2 to 50 days, an average of 15 days between the first and last application of trichloroacetic acid 90%. No recurrences were observed during 1 year of follow-up. All of the clefts were totally repaired, and all of the patients were satisfied with the aesthetic results. CONCLUSIONS: Considering the surgical limitations, the noninvasive procedure described here may be considered to be a good option for incomplete earlobe cleft repair because of its good functional and cosmetic results, low cost, minimum risk, and easy application.

As intervenções nas residências terapêuticas: o que a psicanálise tem a dizer sobre essa clínica?

Falar sobre as intervenções clínicas a egressos de longos(AU)

Anatomic relations between the esophagus and left atrium and relevance for ablation of atrial fibrillation.

BACKGROUND: Esophageal injury is a potential complication after intraoperative or percutaneous transcatheter ablation of the posterior aspect of the left atrium. Understanding the spatial relations between the esophagus and the left atrium is essential to reduce risks. METHODS AND RESULTS: We examined by gross dissection the course of the esophagus in 15 cadavers. We measured the minimal distance of the esophageal wall to the endocardium of the left atrium with histological studies in 12 specimens. To measure the transmural thickness of the atrial wall, we sectioned another 30 human heart specimens in the sagittal plane at 3 different regions of the left atrium. The esophagus follows a variable course along the posterior aspect of the left atrium; its wall was <5 mm from the endocardium in 40% of specimens. The posterior left atrial wall has a variable thickness, being thickest adjacent to the coronary sinus and thinnest more superiorly. Behind is a layer of fibrous pericardium and fibrofatty tissue of irregular thickness that contains esophageal arteries of 0.4+/-0.2-mm external diameters. CONCLUSIONS: The nonuniform thickness of the posterior left atrial wall and the variable fibrofatty layer between the wall and the esophagus are risk factors that must be considered during ablation procedure. Esophageal arteries and vagus nerve plexus on the anterior surface of the esophagus may be affected by ablative procedures.

Sistema de informação em saúde: novas fichas de clínica médica para o Hospital das Clínicas da UFMG / Health information system: new medical forms for general practice at the Hospital das Clínicas/UFMG

Os autores apresentam o layout das novas fichas de registro de dados da Primeira Consulta e Retorno para a Clínica Médica e discutem as fontes do Sistema de Informação em Saúde para o atendimento ambulatorial do Hospital das Clínicas da UFMG. As fichas contêm campos homogêneos para registro de dados para todas as clínicas básicas e especialidades, possibilitando o fornecimento de informações geradas a partir de uma única base de dados para todos os usuários: da gerência, do ensaio e da pesquisa.

The authors present the layout for the new forms to be filled with data collected from patients attending the Internal Medicine Clinic, during the first and follow-up visits. They also present an evaluation of the Health Information System for the UFMG University Hospital out patient clinics. The forms already implemented, have common fields, for Internal Medicine as well as specialties. Based on the new forms, it will be possible to generate, from an unique database, reporta to all users (researchers, mannagers, faculties, etc).

O uso da variável ocupação em estudos clínicos e epidemiológicos / Use of the variable occupation in clinical and epidemiological studies

Para conhecer como a ocupação é estudada e como é incorporada pelo saber médico buscou-se a identificação, na literatura médica, dos artigos que fazem referência ou têm a ocupação como variável importante. Usou-se a base de dados Medline/CD-ROM de 1994. Os distúrbios mentais e as doenças crônicas, transmissíveis, cardiovasculares, pulmonares e as ocupacionais foram os grupos de doenças selecionados para representar a área médica. A identificação dos artigos feita através das doenças estudadas, num primeiro momento, com os descritores para ocupação e, num segundo, com o descritor para fator de risco. Foram identifica- dos 27.517 artigos, dos quais 1.566 (5,7%) mencionavam a variável ocupação e 303 (1,1%) apresentavam descritor para fator de risco. Destes 1.566 artigos, cerca de 14% descreviam a ocupação estudada e dos 303 identificados pelo fator de risco apenas oito (2,6%) correlacionavam a ocupação como fator de risco.

In an attempt to learn how occupation is studied and incorporated by medical knowledge, a search was conducted for papers which make reference to or use occupation as an important variable. The Medline/CD-ROM 1994 database was used for this search. Mental disturbances, chronic diseases, transmissible, cardiovascular, pulmonary, and work-related illness were the diseases groups chosen to represent the medical field. The identification of references was done by cross-referencing the diseases first with the occupation and then with the risk factor. 27.517 references were identified, of which 1.566 (5,7%) mentioned the variable occupation and 303 (1,1%) the risk factor. Of theses 1.566 references, aproximately 14% described the studied occupation, and the 303 identified by the risk factor, only 8 (2,6%) related occupation as a risk factor.

Modelo de prontuário ambulatorial pediátrico para informatizaçäo: Hospital das Clínicas da Universidade Federal de Minas Gerais / Medical ambulatorial report of pediatrics for informatization: Hospital das Clínicas da Universidade Federal de Minas Gerais

Os estudos sobre o prontuário médico ambulatorial de Pediatria do Hospital das Clínicas da Universidade Federal de Minas Gerais mostraram que este era inadequado para o registro dos dados necessários ao acompanhamento clínico, à pesquisa e ao ensino, e carecia de reformulaçäo que possibilitasse também a informatizaçäo. Para essas reformulaçöes, montou-se uma ficha-síntese de dados sobre o atendimento médico e, a partir deste primeiro modelo, realizou-se um processo de discussäo com professores pediatras da Faculdade de Medicina, resultando nas fichas para 1ª consulta e retorno de Pediatria. O modelo de prontuário proposto incorpora os registros em uma ficha única, de forma a valorizar dados de identificaçäo do paciente e do atendimento médico, usualmente dispersos em vários instrumentos de registro. Reordena a parte referente à anamnese e exame físico, ampliando a visibilidade da descriçäo do caso e facilitando seu acompanhamento e a pesquisa clínica. As fichas foram testadas nos ambulatórios de Medicina Geral de Criança do Hospital das Clínicas/UFMG.

Avaliaçao de dados nosológicos em prontuários ambulatoriais / Evaluation of nosologic data in medical records from outpatient clinics

A medicina social tem enfrentado inúmeras dificuldades na construçao de metodologias que permitam uma correlaçao entre o marco teórico desenhado e a realidade sensível. Nas investigaçoes em saúde coletiva, os dados nosológicos se constituem uma questao de maior importância, pois estes representam as informaçoes básicas sobre as quais se construirao os estudos epidemiológicos, o planejamento e a organizaçao dos serviços de saúde. O estudo se propoe a analisar: (a) os alcances e limites da qualidade dos dados nosológicos contidos em prontuários de pacientes ambulatoriais; (b) os sistemas classificatórios de doença utilizados na organizaçao destes dados. Foram selecionados, por amostra aleatória, 340 prontuários de pacientes de ambulatório do Hospital das Clínicas da Universidade Federal de Minas Gerais, registrados no período de 01/07/87 a 30/06/88. Analisou-se a presença da hipótese diagnóstica (HD) na folha de anmnese e exame físico, a legibilidade e a apresentaçao deste dado. A descriçao das HDs encontradas foram agrupadas segundo o padrao da Classificaçao Internacional das Doenças (CID-9). As HDs que nao se enquadravam na CID foram, também, analisadas. O estudo concluiu que: (a) os dados nosológicos registrados seguem a lógica da CID. Esta tem um padrao no qual enquadra-se o raciocínio clínico, refletindo a concepçao hegemônica da medicina científica. Apesar de buscar em suas contínuas revisoes um maior grau de especificidade, a CID incorporou mecanismos que refletem suas limitaçoes: a existência da categoria de Sinais, Sintomas e Estados Maldefinidos e a presença, em todas as categorias, de um dígito que expressa a nao-especificidade. No estudo realizado, em 83% dos prontuários, as HDs eram codificáveis pela CID, apesar de seu uso nao estar normatizado; 6% das HDs encontravam-se na categoria de Sinais, Sintomas e Estados Mórbidos Maldefinidos e 38% nao possuíam o grau de especificidade pretendido pela CID; (b) a análise das HDs nao-classificáveis evidenciou que a CID nao se incorpora a caracterizaçao de aspectos normais, típicos da pediatria; as conclusoes nosológicas analíticas, presentes na psiquiatria, e a dimensao da doença; (c) nenhum dos sistemas classificatórios alternativos analisados responde aos limites da CID