Outpatient Palliative Care Program: Impact on Home Death Rate in Brazil.

While the positive impact of early palliative care on the quality of life of cancer patients is well established, there is a noticeable research gap in developing countries. This study sought to determine the impact of an outpatient palliative care (OPC) program on the location of death among patients in Brazil. This was a retrospective study including patients with cancer who died between January 2022 and December 2022 in 32 private cancer centers in Brazil. Data were collected from medical records, encompassing demographics, cancer characteristics, and participation in the OPC program. The study involved 1980 patients, of which 32.3% were in the OPC program. OPC patients were predominantly younger (average age at death of 66.8 vs. 68.0 years old, p = 0.039) and composed of women (59.4% vs. 51.3%, p = 0.019) compared to the no-OPC patients. OPC patients had more home/hospice deaths (19.6% vs. 10.4%, p < 0.001), and participation in the outpatient palliative care program strongly predicted home death (OR: 2.02, 95% CI: 1.54-2.64). Our findings suggest a significant impact of the OPC program on increasing home and hospice deaths among patients with cancer in our sample. These findings emphasize the potential of specialized OPC programs to enhance end-of-life care, particularly in low-resource countries facing challenges related to social and cultural dimensions of care and healthcare access.

O farmacêutico na Atenção Primária à Saúde no Brasil: análise comparativa 2014-2017 / The pharmacist in the Brazilian Primary Health Care: a comparative analysis between 2014 and 2017

RESUMO O farmacêutico tem importante papel nas unidades de saúde da Atenção Primária à Saúde (APS). No entanto, ainda são escassos no Brasil estudos que abordem a influência do farmacêutico na rede assistencial de saúde. O artigo tem como objetivo verificar em que medida a inserção dos farmacêuticos nas Unidades Básicas de Saúde (UBS) do País está associada à ampliação de aspectos estruturais das farmácias e à disponibilidade de medicamentos. Trata-se de estudo transversal, retrospectivo e analítico, que utilizou dados secundários do 2º (2014) e 3º (2017) ciclos da avaliação externa do Programa de Melhoria de Acesso e da Qualidade da Atenção Básica (PMAQ-AB) e do Cadastro Nacional de Estabelecimentos de Saúde (CNES). Os resultados mostraram importante centralização na dispensação de medicamentos ao longo do 2º e 3ºs ciclos PMAQ-AB. Em contrapartida, identificou-se melhora nos aspectos estruturais nas farmácias das UBS e incremento tanto na disponibilidade média de medicamentos como no total de UBS com disponibilidade de medicamentos ≥80%. Tais avanços foram ainda maiores na existência de farmacêutico cadastrado na UBS. Evidenciou-se a relevância do farmacêutico na APS no Sistema Único de Saúde, uma vez que sua presença potencializa tanto a disponibilidade de medicamentos como também propicia melhores condições estruturais dos serviços de farmácia da APS.

ABSTRACT The pharmacist play a vital role in PHC. However, studies addressing how pharmacists influence the health care network are still scarce. We aim to verify to what extent the inclusion of pharmacists in PHC Units (UBS) in the country is associated with the expanded structural aspects of pharmacies and drug availability in Brazil. This cross-sectional, retrospective, and analytical study employed secondary data from cycles 2 (2014) and 3 (2017) of the external evaluation of the Improvement of Access and Quality of Primary Care Program (PMAQ-AB) and the National Register of Health Facilities (CNES) databases. The results showed an essential centralization in drug dispensing over PMAQ-AB cycles 2 and 3. In contrast, we identified an improvement in the structural aspects of the UBS pharmaceutical services and an increase in the mean drug availability and the total UBS with drug availability ≥ 80%. Such advances were even more significant in the presence of registered pharmacists at the UBS. We conclude by stating that the presence of pharmacists in the PHC of the Unified Health System (SUS) enhances drug availability and provides better structural conditions for PHC pharmacy services.

Transparency of data on the value chain of medicines in Argentina, Brazil, and Colombia.

Introduction: The transparency of data on the value chain of medicines is crucial for the study and monitoring of the pharmaceutical system. These data may impact medicine pricing negotiations, contribute to patient access to pharmaceutical products, and strengthen health systems. Objective: This study analyzed the national strategies to ensure the transparency of data from medicine cost development to marketing in Argentina, Brazil, and Colombia. Method: A descriptive study was carried out by searching databases, reports, documents, and scientific articles published between January and August 2022 related to rules on transparency and databases, including 1) marketing authorization; 2) pricing; 3) intellectual property; 4) clinical trials; 5) research and development (R&D); and 6) health technology assessment (HTA) of selected biopharmaceuticals. Results: Transparency data, rules, and information are not uniform. The infostructures (organizational capacity for collecting and distributing information) regarding the pharmaceutical value chain in these three countries face limitations in appropriate measures to publicly share data and evidence, including pre-clinical data, clinical data, and costs. None of the countries require transparency about data on research and development costs. All three countries present similar publicization of data on marketing authorization and intellectual property, with some differences. The significant limitations in Argentina include the absence of formal price regulation and data on the volume of medicine purchased and respective amounts paid. Among the three countries, Brazil showed a higher degree of information transparency, perhaps due to the legal regulation that guarantees citizens access to information of public interest. Brazil also stands out in terms of the public availability of HTA reports and pricing, in addition to the highest volume of information. In contrast, Colombia has in place a decree that allows 5 years of trial data exclusivity for new medicines, an act contrary to data transparency. Despite the different stages of transparency, no country has evidenced a robust use of these data in public policy decision-making. Conclusion: The results reinforce the presence of information asymmetry between stakeholders, data fragmentation, data gaps and overlap, and difficulty in comparing available data across the three countries and the use of these data nationally to produce evidence.

Complicações do cateter port a cath: subsídios para os cuidados de enfermagem / Complications of port a cath catheter: subsidies for nursing care

O Sistema Único de Saúde deve estar orientado e capacitado para a atenção integral à saúde do paciente oncológico. Sendo assim, houve o despertar em apreender as complicações clínicas que levavam à retirada do cateter port a cath. Traçamos como objetivos: descrever as complicações que levam a retirada do cateter port a cath no paciente oncológico; analisar as complicações que levam à retirada do cateter port a cath no paciente oncológico, trazendo subsídios para os cuidados de enfermagem. O método apresenta-se como pesquisa documental, de caráter quantitativo e natureza descritiva e retrospectiva de dados extraídos de prontuários, através de um instrumento de coleta de dados. No desdobramento dos achados das complicações relatadas referentes ao cateter port a cath, empregou-se a análise de estatística descritiva e a infecção foi a principal complicação. Conclui-se que o impacto do resultado da pesquisa poderá promover a melhoria da assistência, maior disponibilidade para as mudanças de atitude e comportamento da equipe de enfermagem

The Unified Health System (SUS) should be oriented and trained to provide comprehensive health care for cancer patients. Thus, there was an awakening in learning about the clinical complications that led to the removal of the catheter port a cath. The goals of this research are: to describe and analyze the complications that lead to the removal of the port to cath catheter in cancer patients, bringing subsidies to the nursing care. Documentary, quantitative and descriptive research of data extracted from medical records through an instrument of data collection. In the unfolding of the findings of the reported complications related to the port a cath catheter, the analysis of descriptive statistics was used, and infection was the main complication. The impact of the research result may promote improved care, greater availability for changes in attitude and behavior of the nursing team

An Empirical Component-Based Model for High-Strength Bolts at Elevated Temperatures.

High-strength structural bolts are used in nearly every steel beam-to-column connection in typical steel building construction practice. Thus, accurately modeling the behavior of high-strength bolts at elevated temperatures is crucial for properly evaluating the connection capacity, and is also important in evaluating the strength and stability of steel buildings subjected to fires. This paper uses a component-based modeling approach to empirically derive the ultimate tensile strength and modulus of elasticity for grade A325 and A490 bolt materials based on data from double-shear testing of high-strength 25 mm (1 in) diameter bolts at elevated temperatures. Using these derived mechanical properties, the component-based model is then shown to accurately account for the temperature-dependent degradation of shear strength and stiffness for bolts of other diameters, while also providing the capability to model load reversal.

Estudo de custo-efetividade do prasugrel em pacientes submetidos a angioplastia com implante de stent farmacológico / Prasugrel cost-effectiveness study in patients submitted to angioplasty with stent implantation pharmacological

INTRODUÇÃO: A doença arterial coronariana (DAC), está presente quando um paciente tem um ou mais sintomas, ou complicações de uma oferta inadequada de sangue para o miocárdio, que ocorre geralmente devido à obstrução das artérias coronárias decorrente da aterosclerose. É a primeira causa de óbito nas sociedades modernas. Para melhorar os sintomas, os pacientes com DAC obstrutiva são submetidos com frequência a intervenção coronária percutânea (ICP) com implante de stents. A trombose de stent é uma complicação rara mas grave, que se apresenta como um grande infarto do miocárdio não fatal, geralmente com elevação do segmento ST ou morte. Estima-se que menos de 10 % dos óbitos cardíacos após a colocação do stent são atribuíveis à trombose do stent, sendo a maior parte devido à progressão da doença. Pode ocorrer de forma aguda (dentro de 24 horas), subaguda (dentro de 30 dias) ou até um ano (tardio) ou mais após a colocação do stent. A trombose do stent dentro do primeiro ano p