Escassez de medicamentos e a Assistência Farmacêutica na Pandemia da COVID-19: um relato de experiência / Drug shortage and the pharmaceutical assistance policies' during the COVID-19 pandemic: a management experience report

A pandemia de COVID-19 trouxe grandes desafios aos gestores do Sistema Único de Saúde (SUS), tais como a manutenção de abastecimento de medicamentos utilizados para intubação orotraqueal para pacientes graves, denominado como Kit Intubação (KI). A gestão da assistência farmacêutica (AF) precisou de estratégias inovadoras para a manutenção do abastecimento do KI. Este artigo tem como objetivo descrever a experiência da AF no estado mais populoso do Brasil nas ações relacionadas ao abastecimento do KI durante a pandemia. Trata-se de um relato de experiência sobre a gestão realizada para abastecimento de 22 medicamentos nos estoques de hospitais públicos de administração direta e indireta, sob gestão estadual e municipal. Dentre as principais ações realizadas pela Coordenadoria de Assistência Farmacêutica da Secretaria de Estado da Saúde de São Paulo, temos: gestão do abastecimento e elaboração de relatórios gerenciais; centralização da logística de distribuição de medicamentos; gestão de compras nacionais e internacionais, gestão documental, financeira e de estratégias de comunicação. Conclui-se que as ações gerenciais da AF foram fundamentais para o sucesso do monitoramento e a manutenção de estoques hospitalares no momento de escassez do KI assim como trabalho em equipe e articulação junto aos gestores da AF. (AU)

The COVID-19 pandemic has posed a significant challenge for managers of the Bra-zilian Unified Health System (SUS), particularly in ensuring an adequate supply of tracheal intubation medicines, commonly referred to as the intubation kit (IK). The availability and distribution of these drugs are crucial for the treatment of critically ill patients. To address this issue, the Pharmaceutical Assistance's Services and Policies (PASP) management has implemented innovative strategies for the supply of IK. This article aims to describe the experience of PASP in the most populous state of Brazil in the actions taken to manage the supply of IK during the peak of the COVID-19 pandemic. This management report focuses on 22 medicines sto-cked in publichospitals under the direct management of the State or City Council, with some of these hospitals being managed through contractual arrangements with social healthcare organizations.The coordination of PASP, supervised by the Sao Paulo State Health Department, employed various methods, including supply and distribution management, daily management reports from hospitals as part of the State Contingency Plan, centralized logistics for IK distribution, a document mana-gement system to track IK orders, the importation of medicines from abroad, and the management of documents, finances, and strategic communications. In conclu-sion, the actions taken to improve PASP management were crucial in monitoring the availability of IK during the shortage of medicines.The success of these efforts was greatly dependent on teamwork and effective coordination among all PASP managers involved. (AU)

Consumer acceptance of using a digital technology to manage postpartum depression.

The goal of the study was to evaluate the end user experience using the MamaLift Plus app for 2 weeks to support the treatment of their postpartum depression (PPD). A total of 14 participants completed the study and their experiences are reported in this publication. Participants reported that MamaLift Plus is an acceptable, highly usable, and practical mobile tool to use weekly for the management of their PPD. More research is warranted to evaluate the benefit of digital behavior health interventions, especially in patient populations where mental health care may be limited or harder to access by patients.

A Communication Perspective on What Patient Advisory Boards Do: Action-Implicative Discourse Analysis and Negotiating Advice.

Stakeholder advisory boards are recognized as an essential and useful part of patient-centered research. However, such engagement can involve exchanges of diverse individual experiences, multiple opinions, and strong feelings in the face of researchers' limitations, deadlines, and agendas. Yet, little work examines how these potential tensions occur and are resolved in actual advisory board meetings. This perspective article describes and employs a communication framework for analyzing a patient advisory council (PAC) for a comparative effectiveness study on acupuncture and pain counseling for inpatients with cancer. The framework, Action-Implicative Discourse Analysis (AIDA), is an observational method that examines challenges through recorded and transcribed, naturally occurring interaction. Our analysis focused on two short excerpts from the first PAC meeting to demonstrate members' navigation of advice-giving and advice-receiving-one in which advice was ultimately implemented by the study team and another in which it was deemed unfeasible. Although advice is inherent to the work of all PACs, it often emerges unannounced as negotiated moments, made up of seemingly minor conversation moves. As a recurring event, advice can and should be analyzed and discussed within PACs to improve communication and team dynamics.

Innovations in Payer-Community Partnerships: The EmblemHealth Neighborhood Care Program.

Comprehensive and innovative strategies are needed to address and manage chronic diseases and conditions and to reduce health disparities. EmblemHealth Neighborhood Care (EHNC) sites provide community-based linkages across payers, health providers, and delivery systems and underserved communities using culturally sensitive methods tailored to meet the needs of the community. This article describes this novel initiative and early indicators of its feasibility. Three EHNC sites were established in New York City: Harlem, Cambria Heights, and Chinatown. Each site provides core health and customer services to members and the community. In addition, sites provide tailored services to meet the unique needs of each community. Preliminary data suggest that program and community members are utilizing the sites and returning for follow-up visits. Sites also demonstrate success in cross referral between EHNC teams. The EHNC program is both feasible from the payer's perspective and acceptable to diverse patient populations and settings.

The direct and indirect cost burden of Crohn's disease and ulcerative colitis.

OBJECTIVE: To estimate the direct medical and indirect (absenteeism and short-term disability) cost burden of Crohn's Disease (CD) and Ulcerative Colitis (UC). METHODS: Data were obtained from 1999 to 2005 MarketScan databases. Twelve-month expenditures for patients with CD and UC were compared to expenditures among an equal number of propensity score matched comparison group patients. Regression analysis controlled for demographics and case-mix. RESULTS: Annual medical expenditures were significantly higher for commercially insured CD and UC patients compared to matched comparison group patients ($18,963 vs $5300 for CD patients, $15,020 vs $4982 for UC patients, respectively, all P < 0.001). Indirect costs were also high for employed patients with these conditions. CONCLUSIONS: CD and UC are costly diseases with a significant cost burden related to health care utilization and productivity loss.

Knowledge and beliefs about contraception in urban Latina women.

Our study aimed to identify perceptions Latina women have about four different contraceptive methods and to investigate whether religiosity and acculturation play a role in their contraceptive choice. An observational cross-sectional study was performed at Bellevue Hospital. A questionnaire was given to women in the gynecology outpatient clinics asking about: oral contraceptive pills (OCP's), injectable contraception (DMPA), the Intrauterine device (IUD) and the Ortho-Evra Patch (Patch). In the 102 complete surveys, self identified Latina women were not convinced of the safety of OCPs and DMPA (less than 50% perceived them to be safe) and largely uncertain about the Patch and IUD. Latinas also demonstrated more negative beliefs about the side effects of OCPs and DMPA. In particular, they were concerned about weight gain, method reversibility, and bleeding. There was no substantial correlation between religiosity and contraceptive beliefs. Low level acculturated women were more likely to believe that the IUD and OCPs were harmful, as opposed to their more acculturated counterparts who demonstrated more negative beliefs about the Patch. Overall, Latina women in this study tended to overrate the risks associated with contraceptive use, particularly OCPs and DMPA. The markedly low method confidence suggested by high rates of "unsure" answers is a possible explanation for why Latinas are less adherent with birth control than their white counterparts.

The prostatic utricle is not a Müllerian duct remnant: immunohistochemical evidence for a distinct urogenital sinus origin.

PURPOSE: The embryological origin of the utricle is thought to be a remnant of the fused caudal ends of the müllerian ducts (MDs). Others propose that the urogenital sinus (UGS) contributes either partially or totally to the development of this structure. Using immunohistochemical probes, we provide strong evidence that the utricle is of UGS origin only. MATERIALS AND METHODS: Human fetal prostates, gestational ages 9 to 24 weeks, were serially cross-sectioned. Representative sections were stained with antibodies to p63 (basal cell marker), vimentin (mesoderm marker), uroplakins (marker for urothelium) Pax-2 (expressed in ductal and mesenchyme of urogenital system including the MDs and wolffian ducts) and Ki67 (proliferation). Apoptosis was detected with the TUNEL assay. RESULTS: By 9 weeks there was weak expression of p63 in the basal layer of the UGS. At 11 weeks there was increased staining of p63 in the UGS and some p63 staining of the fused MDs, which expressed Pax-2 at this time. At 14 to 15 weeks as the MDs were undergoing apoptosis, there was an ingrowth of uroplakin-expressing UGS epithelium into the periurethral stroma, which formed a plate of p63 positive cells just beneath the UGS that was Ki67 positive. The remaining caudal MD epithelium was p63 negative and expressed vimentin and Pax-2. By 17 weeks the plate of p63 positive cells elongated forming the utricle that remained p63 positive but Pax-2 and vimentin negative. CONCLUSIONS: We show that the utricle forms as an ingrowth of specialized cells from the dorsal wall of the UGS as the caudal MDs regress.

Transvaginal ultrasound-assisted gynecologic surgery: evaluation of a new device to improve safety of intrauterine surgery.

OBJECTIVE: The purpose of this study was to evaluate a new device that couples any standard transvaginal ultrasound transducer to a special tenaculum by means of a specially designed adaptor that enables real-time ultrasound imaging and guidance of intrauterine surgical procedures. STUDY DESIGN: Forty-five patients who underwent intrauterine surgical interventions were evaluated. Forty of these patients had pregnancy terminations. Three patients had curettage for early pregnancy complications. One patient had a polyp removed, and one patient underwent hysteroscopic submucous myomectomy. Five attending physicians performed 26 procedures. Four residents in training performed 19 procedures. All operators were instructed in the assembly and use of the device before their first procedure. Evaluation of the device was done by means of a detailed questionnaire. RESULTS: The procedures were completed successfully and without complications. The time that was involved for the various components of the surgical procedures was recorded; 83% to 90% of the time the operators felt that the technique increased safety and accuracy for the parameters that were evaluated. They required fewer intrauterine instrument manipulations; in 85% of the cases, they could detect the exact end point of the procedure more accurately. In 12% of cases, the operators felt that the device interfered with the performance of the procedure. CONCLUSIONS: The transvaginal ultrasound-assisted gynecological surgery system provided high-resolution images of the cervical canal and the uterine cavity during all stages of the procedure and provided improved indication of the procedure's end point. The increased safety and accuracy that was reported by most users was encouraging. The transvaginal ultrasound-assisted gynecologic surgery system appears to provide an enhanced alternative to transabdominal ultrasound guidance for intrauterine surgical procedures.